European Journal of Heart Failure Supplements (2017) 19 (Suppl. 2) 5–21 doi:10.1002/ejhf.844 CARDIAC ADULTS Metabolic Recovery During Refractory Cardiac Arrest and Cardiogenic Shock Using Extracorporeal Life Support Zud Babar 1 , YM Ganushchak 1 , NPA Vranken 3 , RHJ Hendrix 1 , TSR Delnoij 2,4 , R Lorusso 1 , PW Weerwind 1,3 1 Departments of Cardiothoracic Surgery, 2 Cardiology, 3 Cardiovascular Research Institute Maastricht – CARIM and 4 Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands Introduction/Aim: Metabolic recovery during veno-arterial extracorporeal life sup- port (VA-ECLS) in cardiogenic shock (CS) and cardiac arrest (CA) patients was investigated. Methods: Between June 2012 and December 2016, 106 adult patients with CS (n=83) or CA (n=23) were included in this retrospective data analysis. Lactate, pH and base defcit levels were collected as surrogate markers of metabolic recovery up to 72 hours after initiation of VA-ECLS at 2.6 ± 0.3 L/min/m 2 . Results: The median support duration in CS patients was longer than in CA patients, 90 hours [22–159] vs. 74 hours [19–136] respectively, p=0.07. Post-ECLS median pH, base defcit and lactate improved signifcantly in the CS group within 2, 8 and 20 hours, respectively (pH from 7.31 [7.21-7.37] to 7.34 [7.24-7.42]; base defcit from -6.3 mmol/L [-12.6 to -3.9] to -4.7 mmol/L [-9.7 to -3.1]; lactate from 3.5 mmol/L [1.3-7.6] to 2.2 mmol/L [1.5-4.0], p<0.05 for all). In the CA group pH, lactate and base defcit showed a relatively faster improvement yet not completely resolved (pH from 7.04 [6.80-7.26] to 7.23 [7.11-7.37] in 2 hours; base defcit from -13.8 mmol/L [-17.4 to -5.7] to -6.0 mmol/L [-15.2 to -4.4] in 2 hours; lactate from 10.9 mmol/L [6.6-12.5] to 4.4 mmol/L [2.8-6.4] in 8 hours, p<0.05 for all). One-year survival without neurological sequelae was 32% in the CS group versus 14% in the CA group. Conclusion: Our results showed timely and sustained metabolic recovery in acute cardiac failure patients supported with VA-ECLS. Clinical outcome, however, remains a challenge in this moribund population. Does Spontaneous Pulsatility Affect Microcirculation in ECPR Patients? Tomáš Bou ˇ cek 1 , Petra Krupi ˇ cková 2 , Zuzana Mormanová 3 , Michal Huptych 4 , Tomáš Belza 2 , Ondˇ rej Šmíd 5 , Aleš Král 5 , Hana Skalická 5 , Aleš Linhart 5 and Jan Bˇ elohlávek 5 . 1 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, 2 Student, First Faculty of Medicine, Charles University, 3 Department of Neonatology, Krajska nemocnice Liberec, 4 Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University 5 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. Introduction/Aim: In our observational study we hypothesized that residual cardiac function, resulting in sustained spontaneously pulsatile blood fow, would signif- cantly affect sublingual microcirculation (as a potential outcome predictor) in cardiac arrest (CA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). Methods: In refractory out-of-hospital CA victims, who were treated by ECPR, we recorded sublingual microcirculation by the Sidestream Dark Field videomicroscopy along with actual values of systemic circulatory parameters, body temperature, ECMO setting, medication, blood gases, lactate, hemoglobin and anamnestic data. Microcirculation was evaluated retrospectively in a blinded fashion and capillary (of diameter ≤ 20 m) parameters were compared between patients versus healthy controls and between patients with pulsatile (pulse pressure ≥ 15 mmHg) versus low/non-pulsatile blood fow. Results: Measurements were performed 29 ± 17 hours post CA. Between enrolled 15 patients (54 ± 11 years old) and 12 healthy volunteers we found signifcant difference in proportion of perfused capillaries (90.6 (84.7 – 95.4) versus 97.5 (96.6 – 99.0) %, p=0.006) and microvascular fow index (2.67 (2.42 – 2.92) versus 3.00 (2.92 – 3.00), p = 0.007), other parameters did not differ. Patient groups with pulsatile versus those with low/non-pulsatile blood fow did not differ neither regarding microcirculatory parameters (see Figure 1) nor in other followed variables (except for pulse pressure and ejection fraction of the left ventricle). Conclusion: We found only slight difference in sublingual microcirculation between patients and healthy controls, which might indicate, that microcirculation is sup- ported effectively by ECPR. Spontaneous pulsatility did not appear to have signif- cant effect on sublingual microcirculation. Figure 1: Sublingual capillary (of diameter ≤ 20 m) microcirculation in ECPR treated patients suffering refractory CA: pulsatile blood fow was set as pulse pressure ≥ 15 mmHg. No signifcant differences were found between the groups. Veno-Arterial and Veno-Venous ECMO-Support for Cardiopulmonary Failure Due to Refractory Pulmonary Embolism (PE) Daniele Camboni 1 , Alois Philipp 1 , Lukasz Kmiec 1 , Bernhard Flörchinger 1 , Thomas Müller 2 , Matthias Lubnow 2 , York Zausig 3 and Christof Schmid 1 1 Department of Cardiothoracic Surgery, 2 Department of Internal Medicine II, 3 Department of Anaesthesiology University Medical Center Regensburg, Germany Introduction/Aim: The preferred ECMO confguration for massive refractory PE is the veno-arterial mode. However, veno-venous support might be appropriate in selected cases. Determinants are elaborated. Methods: We retrospectively reviewed our institutional database including all ECMO runs between January 2006 and January 2017. Out of 1190 ECMO runs, 69 patients were supported for severe PE (VA: 42 patients, VV: 27patients). Results: The attached table displays signifcant differences between both patient populations. More patients (83%) in the VA group were placed on ECMO during CPR or after CPR with return of spontaneous circulation (ROSC). Lactate levels were markedly higher in the VA group, and consecutively lower pH levels were measured. Comparable PaO 2 and PaCO 2 as well as PaO 2 /FiO 2 ratios were seen in both groups. Four patients were switched from VA to VV support, and one from VA to VAV. No patient was switched from VV to VA. Support time was signifcantly longer in the VV group (VA 4.3 ± 4.1 days, vs. VV 13.6 ± 11.3 days; p<0.001). Survival to hospital © 2017 The Authors European Journal of Heart Failure © 2017 European Society of Cardiology, 19 (Suppl. 2), 5–21