ECMO for drug-refractory electrical storm without a reversible trigger: a retrospective multicentric observational study.

Autor: Durães-Campos I; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal., Costa C; Department of Cardiology, São João University Hospital Center, Porto, Portugal., Ferreira AR; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal., Basílio C; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal., Torrella P; Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Neves A; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal., Lebreiro AM; Department of Cardiology, São João University Hospital Center, Porto, Portugal., Pestana G; Department of Cardiology, São João University Hospital Center, Porto, Portugal., Adão L; Department of Cardiology, São João University Hospital Center, Porto, Portugal., Pinheiro-Torres J; Department of Cardiac Surgery, São João University Hospital Center, Porto, Portugal., Solla-Buceta M; Intensive Care Unit, Hospital Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Riera J; Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Chico-Carballas JI; Department of Critical Care, Hospital Álvaro Cunqueiro, Vigo (Pontevedra), Spain., Gaião S; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal., Paiva JA; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal.; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal., Roncon-Albuquerque R Jr; Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal.; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Aug; Vol. 11 (4), pp. 2129-2137. Date of Electronic Publication: 2024 Apr 11.
DOI: 10.1002/ehf2.14756
Abstrakt: Aims: Drug-refractory electrical storm (ES) is a life-threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in drug-refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking.
Methods and Results: Retrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug-refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti-arrhythmic drugs, requiring VA-ECMO for circulatory support. Thirty-four (6%) out of 552 patients with VA-ECMO for cardiogenic shock were included [71% men; 57 (44-62) years], 65% underwent cardiopulmonary resuscitation before VA-ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA-ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter-defibrillator. The drug-refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty-one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA-ECMO, and 29% had heart transplantation. Twenty-seven (79%) survived to hospital discharge (48 (33-82) days). Non-survivors were older [62 (58-67) vs. 54 (43-58); P < 0.01] and had a higher first rhythm disorder-to-ECMO interval [0 (0-2) vs. 2 (1-11) days; P = 0.02]. Seven (20%) had rehospitalization during follow-up [29 (12-48) months], with ES recurrence in 6%.
Conclusions: VA-ECMO bridged drug-refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.
(© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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