Extracorporeal life support for refractory heart failure in polytraumatized patients

The sequel of severe poly-trauma may include myocardial dysfunction followed by acute heat failure and death. The Post-traumatic Cardiomyopathy is a variant of stress cardiomyopathy, characterised by a contractile abnormality with extensive left ventricular circumferential dyskinesia or kinesis with, sometimes, a hyperkinetic apex. We report our experience with refractory cardiogenic shock and/or cardiac arrest, triggered by post-traumatic cardiomyopathy, treated with emergent extracorporeal life support. Methods: From June 2008 to December 2014 we treated 6 adult poly-trauma patients (5 men, 1 woman, mean age: 25.3+/-14.2 years, mean ISS score 55.3+/-16.1) with venoarterial (V-A) extracorporeal life support for refractory to conventional treatment cardiopulmonary failure/ cardiac arrest due to post-truamatic cardiomyopathy. Results: Post-traumatic myocardial dysfunction appeared 13.8+/- 12.2 hours after intensive care unit recovery and rapidly evolved to refractory cardiopulmonary failure and Cardiac Arrest (within 4.4+/-2.6 hours of the onset). At ECLS initiation median pH was 7.10+/-0.16 (6.91-7.25), median lactate was 6.9+/-3.1 (4-10) mmol/L and median vasoactive-Inotropic Score was 194.3+/-52.7 μg/kg/min. Tissue Perfusion improved significantly within 4 h on ECLS. Cardiac function improved gradually but consistently (initial median ejection fraction was 13.6% +/- 5.2%, the median global longitudinal strain test -7.4 +/- 4.7 and at complete recovery (after 59.1 and 73.2 hours) was 63.56% +/- 8,2% and -18.43 +/- 2.5 respectively). Conclusions: In poly-trauma patients, refractory posttraumatic cardiomyopathy predominates in the young and is often associated with severe head injury. Rapid heparinfree ECLS can improve therapy and outcome in the most severe