Is extracorporeal life support contraindicated in elderly patients?

Shunsuke Saito, Takeshi Nakatani, Junjiro Kobayashi, Osamu Tagusari, Ko Bando, Kazuo Niwaya, Hiroyuki Nakajima, Shunichi Miyazaki, Toshikatsu Yagihara, Soichiro Kitamura
Annals of Thoracic Surgery 2007, 83 (1): 140-5

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 (> or = 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.

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