• Solène Le Pennec-Prigent, Erwan Flecher, Vincent Auffret, Guillaume Leurent, Jean-Claude Daubert, Christophe Leclercq, Philippe Mabo, Jean-Philippe Verhoye, and Raphael P Martins.
• 1CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France. 2INSERM, U1414, Clinical Investigation Center, Innovative Technology, Rennes, France. 3INSERM, U1099, Rennes, France. 4Université de Rennes 1, Rennes, France. 5CHU Rennes, Service de Chirurgie Thoracique et Cardio-Vasculaire, France.
• Crit. Care Med. 2017 Mar 1; 45 (3): e281-e289.

ObjectivesExtracorporeal life support is used for patients with severe heart failure as a bridge to heart transplantation or recovery. We aimed at analyzing the efficacy and safety of extracorporeal life support to treat refractory arrhythmic storm responsible for cardiogenic shock in patients resistant to antiarrhythmic drugs.DesignRetrospective study.SettingUniversity Hospital of Rennes, France.PatientsPatients with refractory arrhythmic storm admitted between January 2005 and March 2015.InterventionsPatients with intractable refractory arrhythmic storm and cardiogenic shock despite optimal medical therapy were implanted with an extracorporeal life support. Patients' characteristics and outcomes after extracorporeal life support implantation were analyzed.Measurements And Main ResultsTwenty-six patients (23 men, 52.4 ± 9.2 yr old) were included, most of them having ischemic cardiomyopathy (65.4%). Stable sinus rhythm restoration was immediate in 61.5% of patients and occurred after a median time of 3 hours after extracorporeal life support implantation for the remaining ones. Thirteen patients (50%) eventually died, none of them due to extracorporeal life support-related complications, but mostly due to the occurrence of multiple organ failure, and occurred after a median time of 4 days. The remaining 13 patients (50%) had extracorporeal life support withdrawn after 6.7 ± 3.6 days and were discharged after 34.7 ± 14.7 days after admission. Patients with repetitive ventricular tachycardia/ventricular fibrillation episodes alternating with periods of sinus rhythm at the time of implantation had a better survival than those in refractory ventricular fibrillation (p = 0.017).ConclusionsThis is the largest database of patients temporary implanted with extracorporeal life support for refractory arrhythmic storm responsible for cardiogenic shock resistant to antiarrhythmic drugs. It provides efficient hemodynamic support and survival rate after the implantation is 50%.

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