ExtraCorporeal Life Support (ECLS) restores hemodynamic stability in patients with severe cardiocirculatory failure. However, this circulatory assistance technique has its limits, and the most strongly feared is left ventricular distention, of which the potentially serious consequences range from acute pulmonary edema (APE) to left intraventricular thrombosis. Our hypothesis is that in patients in refractory cardiogenic shock and with laminar flow under peripheral V-A ECLS, IABP use could help to diminish the incidence of acute pulmonary edema (APE).

The clinical evolution of patients with laminar flow under peripheral V-A ECLS who did not receive IABP (group A) has been compared to the clinical evolution of patients who received IABP as a means of APE prevention under peripheral V-A ECLS, while also being subjected to laminar flow under peripheral V-A ECLS (group B). A logistic regression model was used to identify the factors associated with occurrence of severe and symptomatic APE.

Between December 2007 and 2012, 90 patients were subjected to laminar flow under peripheral V-A ECLS that had been implanted subsequent to cardiogenic shock. Mortality and mechanical ventilation duration was not significantly different in either of the two groups. However, clinical APE occurrence was far less frequent in group B (35.1% vs. 88.6% p<0.0001). Study of the radiologic score showed that pulmonary infiltrate was greater in group A (p≤0,001). Centralized pulmonary edema was likewise more frequent in group A (44.6% vs. 5.9%, p<0.0001). Multivariate analysis showed that the non-association of IABP with peripheral V-A ECLS (Odds Ratio [OR]=18.87) was an independent factor associated with the incidence of severe symptomatic APE.

Association of IABP and peripheral V-A ECLS can be considered therapeutically efficient in prevention of severe symptomatic pulmonary edema under peripheral V-A ECLS, even though confirmation would require a randomized study.