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

Autor: Isabel Durães‐Campos, Catarina Costa, Ana Rita Ferreira, Carla Basílio, Pau Torrella, Aida Neves, Ana Margarida Lebreiro, Gonçalo Pestana, Luís Adão, José Pinheiro‐Torres, Miguel Solla‐Buceta, Jordi Riera, Juan Ignacio Chico‐Carballas, Sérgio Gaião, José Artur Paiva, Roberto Roncon‐Albuquerque Jr
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: ESC Heart Failure, Vol 11, Iss 4, Pp 2129-2137 (2024)
Druh dokumentu: article
ISSN: 2055-5822
DOI: 10.1002/ehf2.14756
Popis: Abstract 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
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