Extracorporeal life support in patients with refractory cardiogenic shock: keep them awake.

Autor:	Mohite PN; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK drprashantis@rediffmail.com., Kaul S; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Sabashnikov A; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Rashid N; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Fatullayev J; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Zych B; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Popov AF; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Maunz O; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Patil NP; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Garcia-Saez D; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., DeRobertis F; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Bahrami T; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Amrani M; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Banner NR; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Simon AR; Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2015 Jun; Vol. 20 (6), pp. 755-60. Date of Electronic Publication: 2015 Mar 21.
DOI:	10.1093/icvts/ivv057
Abstrakt:	Objectives: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanically ventilated and therefore prone to complications related to immobility and ventilation. We adopted this 'Awake ECLS' strategy for the patients with refractory cardiogenic shock (RCS) as a bridge to decision. Methods: Sixty-eight patients with RCS were supported by ECLS (All veno-arterial) in years 2010-2014. Patients that could not survive 24 h after ECLS implantation (9 patients) were excluded from the study. Study population constituted 59 patients-'Awake' group (n = 18; maintained awake without intubation) and 'Control' group (n = 41; intubated and required mechanical ventilation). Results: Nine (50%) patients were awake at implantation, with 5 of them remaining free of sedation and ventilator support through to explantation. Nine patients were ventilated at the time of implantation but subsequently extubated and remained non-intubated and ventilator free. Post-ECLS survival at 1 month was 78 and 42% while the survival to discharge was 78 and 37% in awake and control group, respectively. Conclusions: ECLS as a bridge to decision in RCS is effective in restoring adequate systemic perfusion and recovering end-organ function. ECLS can be initiated in awake patients with RCS and patients can be awakened on ECLS. The 'awake ECLS' strategy may avoid complications related to mechanical ventilation, sedation and immobilization. RCS patients supported on ECLS without severe metabolic acidosis, multiorgan failure, intra-aortic balloon pump or uncertain neurological status are more likely to be weaned from the ventilator. Patients that are awake at the time of ECLS implantation are more likely to remain awake during ECLS. (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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