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Shunsuke Saito
Takeshi Nakatani
Junjiro Kobayashi
Osamu Tagusari
Ko Bando
Kazuo Niwaya
Hiroyuki Nakajima
Toshikatsu Yagihara
Soichiro Kitamura
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Ann Thorac Surg 2007;83:140-145
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Is Extracorporeal Life Support Contraindicated in Elderly Patients?

Shunsuke Saito, MDa, Takeshi Nakatani, MDb,*, Junjiro Kobayashi, MDa, Osamu Tagusari, MDa, Ko Bando, MDa, Kazuo Niwaya, MDa, Hiroyuki Nakajima, MDa, Shunichi Miyazaki, MDc, Toshikatsu Yagihara, MDa, Soichiro Kitamura, MDa

a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
b Department of Organ Transplantation, National Cardiovascular Center, Osaka, Japan
c Department of Cardiology, National Cardiovascular Center, Osaka, Japan

Accepted for publication August 2, 2006.

* Address correspondence to Dr Nakatani, Department of Organ Transplantation, National Cardiovascular Center, 5-7-1 Fujishirodai Suita, Osaka 565-8565, Japan. (Email: tnakatan{at}hsp.ncvc.go.jp).

BACKGROUND: Extracorporeal life support (ECLS) using percutaneous extracorporeal membrane oxygenation (ECMO) is now considered an important means of resuscitation for patients suffering from refractory cardiogenic shock. The indications for the use of ECLS have yet to be established, however, and its use for elderly patients is still controversial. We retrospectively evaluated the impact of ECLS on the survival of patients with cardiogenic shock to determine the validity of using ECLS in elderly patients (≥75 years of age).

METHODS: Between 2000 and 2004, 91 patients were emergently placed on percutaneous ECMO. The patients were divided into two groups by age (group 1, n = 79: less than 75 years; group 2, n = 12: 75 years or older), which were compared for clinical outcome. Logistic regression analysis of the variables was performed to identify predictors of ability to be weaned from ECLS.

RESULTS: Weaning from ECLS was achieved in 50 patients in group 1 (63.3%) and 6 patients in group 2 (50%; p = 0.37). Thirty-five patients in group 1 (44.3%) and 5 patients in group 2 (41.7%) were discharged from the hospital (p = 0.86). Logistic regression analysis revealed that patients with a body surface area of more than 1.50 m2, patients with cardiomyopathy, and patients who underwent interventions under ECMO support were more likely to be successfully supported by ECMO.

CONCLUSIONS: Extracorporeal life support using percutaneous ECMO systems provides excellent cardiac support. It is also effective in resuscitating elderly patients, yielding hospital survival similar to that for younger patients.


Related Article

Invited commentary
Ulrich F.W. Franke
Ann. Thorac. Surg. 2007 83: 145. [Extract] [Full Text] [PDF]





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