The authors retrospectively reviewed their institution's experience wi
th extracorporeal life support (ECLS) for adult cardiovascular failure
to determine efficacy and further indications for its use. From 1985
to 1996, venoarterial ECLS was used in 27 adult patients. Indications
for ECLS included post cardiotomy cardiac failure, primary myocardial
failure, bridge to transplant, and emergency cardiopulmonary resuscita
tion. The average age was 38.7 +/- 2.7 years and duration of support w
as 164.0 +/- 26.8 hr. Overall cardiovascular recovery from ECLS was 44
%, and hospital survival was 30%. Late deaths were due to multisystem
organ failure. Best results were obtained in patients whose processes
were reversible during a short duration of ECLS (<91.6 +/- 33.3 hr). T
he worst results were obtained in post cardiotomy patients who underwe
nt prolonged support with ECLS. Evaluation of physiologic parameters d
uring the first 30-48 hr of support showed marked improvements from va
lues before ECLS. Because of its relative ease of deployment and its r
apid correction of acute physiologic derangements, ECLS can be used as
a temporary means of support to determine extent and reversibility of
organ dysfunction. Longer term support should include consideration o
f other mechanical assist devices. The authors no longer consider brid
ge to transplant an indication for ECLS due to relative donor unavaila
bility.