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Extracorporeal membrane oxygenation’s role in refractory electrical storm with no straightforward treatment - how much time worths?
Session:
Comunicações Orais - Sessão 13 - Taquicardia Ventricular e Morte Súbita Cardíaca
Speaker:
Catarina Costa
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Martins Da Costa; Isabel Durães Campos; Ana Rita Ferreira; Ana Lebreiro; Gonçalo Pestana; Luis Adão; Luis Filipe Macedo; José Pinheiro Torres; Jose Artur Paiva; Roberto Roncon-Albuquerque Jr
Abstract
<p><strong>Background </strong>Refractory electrical storm is a very severe condition that may be rescued by percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). ECMO data in this context are limited. The authors aimed to study the utility of emergency VA-ECMO in rES with no specific treatment.</p> <p><strong>Methods </strong>Retrospective study of rES cases supported with VA-ECMO at a tertiary centre from April 1st 2016 to June 1st 2022. Patients with acute coronary syndrome (<48h) or with evident treatment were not included. Follow-up data was retrieved from electronic records.</p> <p><strong>Results</strong> Sixteen patients were included (49±18 years-old), most men and with cardiovascular risk factors. Ten patients were admitted with ongoing rES. Cardio-respiratory arrest pre-VA-ECMO cannulation occurred in 11 patients. VA-ECMO was started 4 (8) days post-admission and was maintained for 14 ± 9 days. Definitive treatment included antiarrhythmic drugs (4, 25%; 2 of them with concomitant myocarditis treatment); emergency heart transplant (4, 25%); electrophysiological<br /> study and catheter ablation (3, 19%); and sympathetic blockage (1, 6%). In 3 refractory cases, palliative care was provided. Thirteen patients that underwent VA-ECMO due rES were discharged with no concomitant neurological deficits (overall survival: 81%). Half of patients presented minor vascular complications, and one had a major fatal complication. During follow-up, 19 ± 16 months, no rES recurrence was reported. See table 1 for detailed data.</p> <p><strong>Conclusion</strong> In this single-centre study, emergency VA-ECMO offered valuable hemodynamic support in rES, allowing patient stabilization until definitive treatment in a high proportion of cases. A multi-disciplinary approach was crucial for the survival of these patients and included an intensive care medicine department with a high-volume ECMO centre, a cardiology department with an electrophysiology laboratory and a thoracic surgery department with a heart transplant program.</p>
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