Top

Published in:

01-01-2020 | Cardiogenic Shock | Original Paper

Real-world clinical experience with the percutaneous extracorporeal life support system: Results from the German Lifebridge^® Registry

Authors: Maryna Masyuk, Peter Abel, Martin Hug, Bernhard Wernly, Assad Haneya, Stefan Sack, Konstantinos Sideris, Nicolas Langwieser, Tobias Graf, Georg Fuernau, Marcus Franz, Ralf Westenfeld, Malte Kelm, Stephan B. Felix, Christian Jung

Published in: Clinical Research in Cardiology | Issue 1/2020

Abstract

Background

The concept of percutaneous extracorporeal life support (ECLS) is based on immediate cardiovascular stabilization allowing for sufficient end-organ perfusion, thus improving the outcome in patients with circulatory arrest. Lifebridge^® (Zoll Medical GmbH, Germany) is a portable ECLS device designed for rapid application due to its automated set-up.

Methods

A total of 60 tertiary cardiovascular centers were interrogated with regard to application and short-term results after use of Lifebridge ECLS system. Detailed data were collected by standardized case report forms in all centers consented to participate in the study. Demographic and clinical baseline characteristics of the patient population, procedural and follow-up data were recorded and analyzed.

Results

In total, 444 patients were analyzed regarding mortality. The detailed study cohort consisted of 112 patients. A total of 80% of the study subjects represented patients post cardiopulmonary resuscitation, 43% were in cardiogenic shock and 50% suffered from acute myocardial infarction. The survival rates were 36% immediately after device implementation and 16% after 30 days. Multivariable analysis revealed that only serum lactate concentration at admission could be proven as independent predictor of patients’ outcome. Patients with lactate concentrations above 10 mmol/L exhibited > 95% mortality (p < 0.05 versus below 10 mmol/L).

Conclusion

The present study provides real-world clinical data of patients treated with a transportable automated ECLS system. In conclusion, Lifebridge is a safely applicable cardiorespiratory stabilization tool associated with acceptable complication rates. Nevertheless, mortality rates were high in these critically ill patients, especially in those showing high lactate concentrations at admission.

Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J (2009) Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 119:1211–1219. https://doi.org/10.1161/CIRCULATIONAHA.108.814947 CrossRefPubMedPubMedCentral

Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634. https://doi.org/10.1056/NEJM199908263410901 CrossRefPubMed

Stretch R, Sauer CM, Yuh DD, Bonde P (2014) National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol 64:1407–1415. https://doi.org/10.1016/j.jacc.2014.07.958 CrossRef

Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, Buerke U, Raaz U, Ebelt H, Schlitt A, Heinroth K, Haerting J, Werdan K, Buerke M (2012) Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardiale infarction complicated by cardiogenetic shock: the prospective, randomized IABP shock trial. Shock Inj Inflamm Sepsis Lab Clin Approaches 37:378–384. https://doi.org/10.1097/SHK.0b013e31824a67af CrossRef

Sjauw KD, Engström AE, Vis MM, van der Schaaf RJ, Baan J, Koch KT, de Winter RJ, Piek JJ, Tijssen JGP, Henriques JPS (2009) A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30:459–468. https://doi.org/10.1093/eurheartj/ehn602 CrossRefPubMed

Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382:1638–1645. https://doi.org/10.1016/S0140-6736(13)61783-3 CrossRefPubMed

Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296. https://doi.org/10.1056/NEJMoa1208410 CrossRefPubMed

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177. https://doi.org/10.1093/eurheartj/ehx393 CrossRef

Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, Agrawal S, Arora S, Patel N, Wald J, Jorde UP (2018) Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 107:287–303. https://doi.org/10.1007/s00392-017-1182-2 CrossRefPubMed

10.

Backhaus T, Fach A, Schmucker J, Fiehn E, Garstka D, Stehmeier J, Hambrecht R, Wienbergen H (2018) Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol 107:371–379. https://doi.org/10.1007/s00392-017-1192-0 CrossRefPubMed

11.

Thiele H, Smalling RW, Schuler GC (2007) Percutaneous left ventricular assist devices in acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 28:2057–2063. https://doi.org/10.1093/eurheartj/ehm191 CrossRefPubMed

12.

Jung C, Janssen K, Kaluza M, Fuernau G, Poerner TC, Fritzenwanger M, Pfeifer R, Thiele H, Figulla HR (2016) Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol 105:196–205. https://doi.org/10.1007/s00392-015-0906-4 CrossRefPubMed

13.

Chen Y-S, Lin J-W, Yu H-Y, Ko W-J, Jerng J-S, Chang W-T, Chen W-J, Huang S-C, Chi N-H, Wang C-H, Chen L-C, Tsai P-R, Wang S-S, Hwang J-J, Lin F-Y (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561. https://doi.org/10.1016/S0140-6736(08)60958-7 CrossRefPubMed

14.

Jung C, Schlosser M, Figulla H-R, Ferrari M (2009) Providing macro- and microcirculatory support with the Lifebridge System during high-risk PCI in cardiogenic shock. Heart Lung Circ 18:296–298. https://doi.org/10.1016/j.hlc.2008.05.601 CrossRefPubMed

15.

Jung C, Franz M, Figulla H-R, Sonntag S, Hug M, Mudra H, Bauerschmitt R, Kleber F-X, Feindt P, Mehlhorn U, Vahl C, Bruns H-J, Ferrari M (2015) Percutaneous extracorporeal life support in patients with circulatory failure: results of the German Lifebridge Registry. J Invasive Cardiol 27:93–97PubMed

16.

Paden ML, Conrad SA, Rycus PT, Thiagarajan RR (2013) Extracorporeal life support organization registry report 2012. ASAIO J 59:202–210. https://doi.org/10.1097/MAT.0b013e3182904a52 CrossRefPubMed

17.

Rogers JG, O’Connor CM (2014) The changing landscape of advanced heart failure therapeutics. J Am Coll Cardiol 64:1416–1417. https://doi.org/10.1016/j.jacc.2014.04.085 CrossRefPubMed

18.

Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol BAJM, Henriques JPS (2016) Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 42:1922–1934. https://doi.org/10.1007/s00134-016-4536-8 CrossRefPubMedPubMedCentral

19.

Ouweneel DM, Henriques JPS (2012) Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations. Heart 98:1246–1254. https://doi.org/10.1136/heartjnl-2012-301963 CrossRefPubMed

20.

Werdan K, Gielen S, Ebelt H, Hochman JS (2014) Mechanical circulatory support in cardiogenic shock. Eur Heart J 35:156–167. https://doi.org/10.1093/eurheartj/eht248 CrossRefPubMed

21.

de Waha S, Fuernau G, Desch S, Eitel I, Wiedau A, Lurz P, Schuler G, Thiele H (2016) Long-term prognosis after extracorporeal life support in refractory cardiogenic shock: results from a real-world cohort. EuroIntervention 11:1363–1371. https://doi.org/10.4244/EIJV11I12A265 CrossRefPubMed

22.

Dzavik V, Sleeper LA, Cocke TP, Moscucci M, Saucedo J, Hosat S, Jiang X, Slater J, LeJemtel T, Hochman JS (2003) Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry. Eur Heart J 24:828–837CrossRef

23.

de Waha S, Graf T, Desch S, Fuernau G, Eitel I, Pöss J, Jobs A, Stiermaier T, Ledwoch J, Wiedau A, Lurz P, Schuler G, Thiele H (2017) Outcome of elderly undergoing extracorporeal life support in refractory cardiogenic shock. Clin Res Cardiol 106:379–385. https://doi.org/10.1007/s00392-016-1068-8 CrossRefPubMed

24.

Parissis H, Soo A, Al-Alao B (2011) Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg 6:147. https://doi.org/10.1186/1749-8090-6-147 CrossRefPubMedPubMedCentral

25.

Vellinga NAR, Boerma EC, Koopmans M, Donati A, Dubin A, Shapiro NI, Pearse RM, van der Voort PHJ, Dondorp AM, Bafi T, Fries M, Akarsu-Ayazoglu T, Pranskunas A, Hollenberg S, Balestra G, van Iterson M, Sadaka F, Minto G, Aypar U, Hurtado FJ, Martinelli G, Payen D, van Haren F, Holley A, Gomez H, Mehta RL, Rodriguez AH, Ruiz C, Canales HS, Duranteau J, Spronk PE, Jhanji S, Hubble S, Chierego M, Jung C, Martin D, Sorbara C, Bakker J, Ince C (2017) Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Crit Care 21:255. https://doi.org/10.1186/s13054-017-1842-7 CrossRefPubMedPubMedCentral

26.

Vink EE, Bakker J (2018) Practical use of lactate levels in the intensive care. J Intensive Care Med 33:159–165. https://doi.org/10.1177/0885066617708563 CrossRefPubMed

27.

Kiyatkin ME, Bakker J (2017) Lactate and microcirculation as suitable targets for hemodynamic optimization in resuscitation of circulatory shock. Curr Opin Crit Care 23:348–354. https://doi.org/10.1097/MCC.0000000000000423 CrossRefPubMed

28.

Masyuk M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM, Zimmermann G, Lauten A, Schulze PC, Hoppe UC, Kelm M, Bakker J, Jung C (2019) Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med 45:55–61. https://doi.org/10.1007/s00134-018-5475-3 CrossRefPubMed

29.

Jung C, Bueter S, Wernly B, Masyuk M, Saeed D, Albert A, Fuernau G, Kelm M, Westenfeld R (2019) Lactate clearance predicts good neurological outcomes in cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation. J Clin Med. https://doi.org/10.3390/jcm8030374 CrossRefPubMedPubMedCentral

30.

O’Neill WW, Kleiman NS, Moses J, Henriques JPS, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126:1717–1727. https://doi.org/10.1161/CIRCULATIONAHA.112.098194 CrossRefPubMed

31.

Thiele H, Allam B, Chatellier G, Schuler G, Lafont A (2010) Shock in acute myocardial infarction: the Cape Horn for trials? Eur Heart J 31:1828–1835. https://doi.org/10.1093/eurheartj/ehq220 CrossRefPubMed

32.

Becher PM, Schrage B, Sinning CR, Schmack B, Fluschnik N, Schwarzl M, Waldeyer C, Lindner D, Seiffert M, Neumann JT, Bernhardt AM, Zeymer U, Thiele H, Reichenspurner H, Blankenberg S, Twerenbold R, Westermann D (2018) Venoarterial extracorporeal membrane oxygenation for cardiopulmonary support. Circulation 138:2298–2300. https://doi.org/10.1161/CIRCULATIONAHA.118.036691 CrossRefPubMed

33.

Donker DW, Brodie D, Henriques JPS, Broomé M (2019) Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion 34:98–105. https://doi.org/10.1177/0267659118794112 CrossRefPubMed

34.

Schrage B, Burkhoff D, Rübsamen N, Becher PM, Schwarzl M, Bernhardt A, Grahn H, Lubos E, Söffker G, Clemmensen P, Reichenspurner H, Blankenberg S, Westermann D (2018) Unloading of the left ventricle during venoarterial extracorporeal membrane oxygenation therapy in cardiogenic shock. JACC Heart Fail 6:1035–1043. https://doi.org/10.1016/j.jchf.2018.09.009 CrossRefPubMed

35.

Lee JS, Roberts SWP, Götsch K, Moeller U, Hawryluck L (2019) Caring for critically ill patients in humanitarian settings. Am J Respir Crit Care Med 199:572–580. https://doi.org/10.1164/rccm.201806-1059CP CrossRefPubMed

Title: Real-world clinical experience with the percutaneous extracorporeal life support system: Results from the German Lifebridge® Registry
Authors: Maryna Masyuk
Peter Abel
Martin Hug
Bernhard Wernly
Assad Haneya
Stefan Sack
Konstantinos Sideris
Nicolas Langwieser
Tobias Graf
Georg Fuernau
Marcus Franz
Ralf Westenfeld
Malte Kelm
Stephan B. Felix
Christian Jung
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Cardiogenic Shock
Cardiogenic Shock
Published in: Clinical Research in Cardiology / Issue 1/2020
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01482-2

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Real-world clinical experience with the percutaneous extracorporeal life support system: Results from the German Lifebridge^® Registry

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Right atrial–right ventricular coupling in heart failure with preserved ejection fraction

When and how do patients with cardiac amyloidosis die?

Sex differences in optimal atrioventricular delay in patients receiving cardiac resynchronization therapy

Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI)

Correction to: Antithrombotic therapy in atrial fibrillation: stop triple therapy and start optimizing dual therapy?

Cardioverter–defibrillator does not improve short-term survival among patients with non-ischemic cardiomyopathy and reduced left ventricular ejection fraction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page