SPC365

Peripheral venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: single-center experience

Session: Comunicações Orais (Sessão 6) - DAC e Cuidados Intensivos 2 - Vários Tópicos
Speaker: Daniel A. Gomes

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Comunicações Orais
FP Number: ---
Authors: Daniel a. Gomes; Francisco Albuquerque; Christopher Strong; Pedro m. Lopes; Catarina Brízido; Sara Ranchordàs; Miguel Sousa Uva; Miguel Abecassis; Jorge Ferreira; António Tralhão; José Pedro Neves

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Background:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides short-term circulatory and respiratory support to patients with or at risk of refractory cardiogenic shock. Although reports are heterogeneous, complication and mortality rates remain high even in the most experienced centers. The aim of this study was to describe our experience using peripheral VA-ECMO for refractory cardiogenic shock.&nbsp; </span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Methods:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">All patients undergoing peripheral VA-ECMO implantation from January 2015 to November 2021 for refractory cardiogenic shock were retrospectively identified at a single-center. Indications, VA-ECMO-related complications, in-hospital and 30-day mortality were assessed. Predictors of in-hospital mortality were identified on multivariable analysis.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Results:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">A total of 46 patients (median age 55 years [IQR 40-63]; 73.9% male) were included, most with a femoro-femoral VA-ECMO configuration (n=43; 93.5%). The most common clinical indications were cardiogenic shock due to acute myocardial infarction (n=17; 40.0%), post-cardiotomy (n=9; 19.6%) and acute decompensated heart failure (n=7; 15.2%) &ndash; <strong><span style="color:#4472c4">table 1</span></strong>. Overall, 40.0% suffered pre-implantation cardiac arrest, most patients were at SCAI class D (n=37; 80.4%) and median SAVE score was 0 (IQR -6 to 2). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">VA-ECMO-related complications were frequent, with at least one occurring in 33 patients (71.7%). The most common complications were access-site related (limb bleeding or ischemia in 24 patients [52.2%]) &ndash; <strong><span style="color:#4472c4">table 1</span></strong>. 66.7% had a distal perfusion cannula and left ventricular (LV) venting strategies were applied in 3 cases (6.5%). A total of 21 patients (45.6%) were successfully weaned, of which 8 (38.1%) ultimately received a heart transplant or a durable LV assist device. 30-day and in-hospital mortality were 56.5% and 65.2%, respectively, with non-cardiovascular mortality accounting for more than one third of all deaths. On multivariate analysis, SAVE score (HR 1.17 per each 1-point decrease; 95% CI: 1.03&ndash;1.32; p = 0.015) and the presence of any VA-ECMO-related complication (HR 4.94; 95% CI: 1.05&ndash;23.3; p = 0.04) were independent predictors of in-hospital mortality.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Conclusion:</span></strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">In our small series, mortality in patients undergoing peripheral VA-ECMO implantation was high but similar to large-volume centers. Despite improved cannulation strategies, vascular complications remain frequent. Specialized post-implantation management should reduce the impact of device related morbidity and mortality.</span></span></span></p>