ECMO for drug-refractory electrical storm without a reversible trigger: a retrospective multicentric observational study

Data de publicação: 01/08/2024 Data Ahead of Print: 01/04/2024

Autores da FMUP

José Artur Osório De Carvalho Paiva

Autor

Participantes de fora da FMUP

Duraes-Campos, Isabel
Costa, Catarina
Ferreira, Ana Rita
Basilio, Carla
Torrella, Pau
Neves, Aida
Lebreiro, Ana Margarida
Pestana, Goncalo
Adao, Luis
Pinheiro-Torres, Jose
Solla-Buceta, Miguel
Riera, Jordi
Chico-Carballas, Juan Ignacio
Gaiao, Sergio
Roncon-Albuquerque Jr, Roberto

Unidades de investigação

Medicina

Abstract

Aims Drug-refractory electrical storm (ES) is a life-threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in drug-refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking. Methods and results Retrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug-refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti-arrhythmic drugs, requiring VA-ECMO for circulatory support. Thirty-four (6%) out of 552 patients with VA-ECMO for cardiogenic shock were included [71% men; 57 (44-62) years], 65% underwent cardiopulmonary resuscitation before VA-ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA-ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter-defibrillator. The drug-refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty-one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA-ECMO, and 29% had heart transplantation. Twenty-seven (79%) survived to hospital discharge (48 (33-82) days). Non-survivors were older [62 (58-67) vs. 54 (43-58); P < 0.01] and had a higher first rhythm disorder-to-ECMO interval [0 (0-2) vs. 2 (1-11) days; P = 0.02]. Seven (20%) had rehospitalization during follow-up [29 (12-48) months], with ES recurrence in 6%. Conclusions VA-ECMO bridged drug-refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.

Dados da publicação

ISSN/ISSNe:: 2055-5822, 2055-5822
Tipo:: Article
Páginas:: 2129-2137
DOI:: 10.1002/ehf2.14756
Link para outro recurso:: www.scopus.com

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Keywords

Antiarrhythmic drugs; Catheter ablation; Electrical storm; Extracorporeal membrane oxygenation; Heart transplantation

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Proyectos asociados

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