EXTRACORPOREAL LIFE-SUPPORT FOR CARDIOVASCULAR SUPPORT IN ADULTS

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.