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MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque

RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK. MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque Groupe Hospitalier Pitié-Salpêtrière

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MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque

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  1. RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque Groupe Hospitalier Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris Paris, France

  2. Between February 2006 and November 2009 • 745 ECLS V-V and V-A • 77 ECLS support for AMI with CS - 59 peripheral - 18 central • 67% after PCA or cardiac surgery

  3. Demographicsand comorbidity

  4. Haemodynamics data

  5. Laboratory data pre-implantation

  6. Inotropes at ECLS implantation

  7. Strategy • ECLS implantation to provide immediate circulatory support for hemodynamic stabilization • Patients who had no signs of recovery after 3 weeks were considered candidates for: • transplantation • LVAD implantation

  8. ECLS weaning • pulsatile arterial waveform • MBP >60 mmHg while receiving no or low-dose vasoactive agents • good pulmonary blood oxygenation ECLS flow decreasedprogressively • LVEF ≥ 25% • ITV ≥ 12 cm

  9. Causes of death

  10. Causes of death

  11. Multivariateanalysis of 30 daysmortalityriskfactors

  12. Traitement of pulmonaryedemaduringperipheral ECLS • Inotropes • IABP • Impella LP 2.5 and 5.0 • Central ECLS

  13. Double Central ECLS

  14. Conclusions • Prompt ECLS support is an effective management and provides a reasonable chance of survival in much compromised patient with AMI associated with profound CS • Reducingthe duration of end organsischemiais the keystone of management for thesepatients

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