SPC365

Left Ventricle Unloading Techniques in VA-ECMO: A Comparative Analysis in Cardiogenic Shock Patients

Session: Comunicações Orais - Sessão 01 - Choque cardiogénico e transplante cardíaco
Speaker: Marta Leite

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.6 Acute Heart Failure - Clinical
Session Type: Comunicações Orais
FP Number: ---
Authors: Marta Leite; Fábio Nunes; Daniel Caeiro; Marisa Silva; Gustavo Pires-Morais; Mariana Ribeiro Silva; Pedro Gonçalves Teixeira; Marta Ponte; Adelaide Dias; Lino Santos; Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif"><strong>Introduction:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has significantly advanced the management of patients in refractory cardiogenic shock. Nevertheless, the retrograde delivery of oxygenated blood to the aorta via the arterial cannula&nbsp;imposes increased afterload on an already strained left ventricle (LV). </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">Our study aims to compare the clinical outcomes of patients on VA-ECMO with additional invasive techniques to unload the LV against those without unloading strategies.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif"><strong>Methods:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">Patients admitted to our hospital requiring VA-ECMO were categorized into two groups: the Unloading Group (UG) that received LV unloading interventions and the Non-Unloading Group (Non-UG) without such interventions. We collected comprehensive clinical data, including demographics, baseline characteristics, ECMO-related parameters, in-hospital complications, and patient outcomes. Statistical analyses involved chi-square tests for categorical variables and independent samples t-tests for continuous variables.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">In the period between January 2011 and October 2023, our cardiac intensive care unit treated 85 patients with VA-ECMO (mean age 54.5 &plusmn; 11.9 years, 61.2% male). Notably, acute coronary syndrome was the primary cause of refractory cardiogenic shock necessitating VA-ECMO (31.4% Non-UG vs. 70.6% UG). </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">Approximately 34 patients received LV unloading support. The choice of unloading device was guided by our centre&#39;s expertise and attended physician preference.&nbsp;Intra-Aortic Balloon Pump (IABP) was the most commonly used (64.7%), followed by Impella CP (20.6%). Unloading devices were implemented either concurrently with VA-ECMO cannulation (61.8%) or after its insertion (38.2%). </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">No significant differences were observed in the median duration of VA-ECMO (4 days UG vs. 3 days Non-UG, p=0.25) or in the median duration of hospitalization (12 days UG vs. 13 days Non-UG, p=0.619) between the two groups. </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">The UG experienced more thromboembolic events despite not reaching statistical significance (38.2% UG vs. 21.6% Non-UG, p=0.752).&nbsp;A higher incidence of bleeding events was also reported in the UG, and particularly&nbsp;airway bleeding&nbsp;was significantly more common in the UG (20.6% UG vs.&nbsp;3.9% Non-UG, p=0.0369).&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">The 30-day survival rates were 31% (95% CI, 0.19-0.53) in the UG and 50% (95% CI, 0.35-0.70) in the Non-UG, which did not display statistical significance (p=0.11) [Figure 1].</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">In our cohort, incorporating unloading devices alongside VA-ECMO did not yield major differences in survival rates. The precocity of unloading device implantation, either as an initial strategy or to prevent increased afterload in hearts with limited contractile reserve, should be carefully weighed against associated risks and complications.</span></span></p>