ANALYSIS OF CLINICAL TRENDS IN A PROGRAM OF EMERGENT ECLS FOR CARDIOVASCULAR COLLAPSE

Between June 1986 and October 1995, 81 patients were emergently resusc itated with a portable extracorporeal life support (ECLS) system. Veno arterial perfusion was achieved using a centrifugal pump (BioMedicus; Medtronic, Anaheim, CA) and a hollow fiber oxygenator (BARD in 56 pati ents; Medtronic heparin-bonded MAXIMA [MAXIMA, Medtronic, Minneapolis, MN] in the last 25 patients). The ECLS system was used at various loc ations in the hospital with the setup, priming, and initiation of perf usion done by ECLS trained intensive care unit nurses. Clinical data o n these patients were reviewed to analyze variables influencing surviv al and trends that developed as the authors' experience accumulated an d the technology evolved. The indication for ECLS was cardiac arrest i n 68 patients and refractory cardiogenic shock in 13 patients. Thirty- five patients (43.2% survived >24 hrs after termination of ECLS, where as 20 patients (24.7%) are longterm survivors (>30 days). The ECLS sys tem permitted an additional therapeutic surgical intervention in 45 ca ses. Patients who had a surgically remediable problem were more likely to survive. prolongation of cardiopulmonary resuscitation beyond 30 m ins before initiation of ECLS correlated with a decreased likelihood o f survival.