Extracorporeal life support for cardiovascular support in adults

The authors retrospectively reviewed their institution's experience with 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 resuscitation. The average age was 38.7 +/- 2.7 years and duration of support was 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). The worst results were obtained in post cardiotomy patients who underwent prolonged support with ECLS. Evaluation of physiologic parameters during the first 30-48 hr of support showed marked improvements from values before ECLS. Because of its relative ease of deployment and its rapid 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 of other mechanical assist devices. The authors no longer consider bridge to transplant an indication for ECLS due to relative donor unavailability.