Extracorporeal life support in adults with hemodynamic collapse from fulminant cardiomyopathies: the chance of bridging to recovery

Venoarterial extracorporeal life support (VA-ECLS) is a lifesaving circulatory support in hemodynamic collapse induced by miscellaneous etiologies. However, survival rates vary among etiologies. To investigate the therapeutic effectiveness of VAECLS in hemodynamic collapse induced by fulminant cardiomyopathy (CM), a retrospective chart review of 14 patients was conducted, among the 294 adults receiving VA-ECLS in a single institution from April 2006 to April 2013. All patients received echocardiography, coronary angiography, or computed tomography before or immediately after undergoing VA-ECLS to exclude anatomic cardiac diseases. Myocarditis (n = 12) and peripartum CM (n = 2) were the subcategories of fulminant CM. The median door-to-ECLS duration was 12 hours. Seven patients received cardiopulmonary resuscitation (CPR) before VA-ECLS, and three required ECLS-assisted CPR to regain circulation. Two patients were transplanted as a result of myocardial irreversibility and one survived. Nine of the nontransplant patients survived after a median VA-ECLS of 167 hours. All of the 10 survivors, including the five experiencing dialysis-dependent acute renal failure, had their cardiac and renal function return to normal within 6 months after the episode. The VA-ECLS was a practical therapeutic option in fulminant CM. It could provide expeditious hemodynamic support and preserve organ viability essential to recovery. ASAIO Journal 2014; 60:664-669.