Trauma-induced cardiomyopathy requiring emergency extracorporeal life support

Introduction: The sequelae of severe poly-trauma may include myocardial dysfunction followed by acute heart failure and death. Trauma-induced cardiomyopathy or Inverted-Takotsubo Cardiomyopathy (ITC) is a variant of stress cardiomyopathy, characterized by a contractile abnormality with extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. We report our experience with refractory cardiogenic shock and/or cardiac arrest, treated with extracorporeal life support. Methods: From June 2008 to December 2015, we treated 6 adult poly-trauma patients (5 men, 1 woman,mean age: 28.4±15.4 years,mean ISS score 52.5±17.2) with veno-arterial (V-A) extracorporeal life support for cardiopulmonary failure/ cardiac arrest refractory to conventional treatment, due to inverted-Takotsubo cardiomyopathy. We used a miniaturized extracorporeal life support (ECLS) device. RESULTS. ITC myocardial dysfunction appeared 14.6±12.4 h after intensive care unit admission and rapidly evolved to refractory cardiopulmonary failure and cardiac arrest (within 3.4±3.2 h of the onset). At ECLS, initiation median pH was 7.11±0.15 (6.91-7.25), median lactate was 6.9±3.1 (4-10) mmol/l and median vasoactive-inotropic score was 184.4±51.4 μg/kg/min. Tissue perfusionimproved significantly within 4 h on ECLS. Cardiac function improved gradually but consistently. Initial median ejection fraction was 12.8±5.1% and median global longitudinal strain test was -7.1±4.8. At complete cardiac recovery, they were 60.51±8.1 and -17.83±3.2%, respectively. After that, 2 patients survived and were sent to neurological rehabilitation before hospital discharge. In the other 2 cases, post-traumatic cerebral death occurred and they underwent organ explantation. Conclusions: Rapid heparin-free ECLS may improve outcome in the most severe cases of poly-traumatized patients demonstrating refractory trauma-induced cardiomyopathy.