SPC365

Cardiogenic Shock Management with Venoarterial Extracorporeal Membrane Oxygenation: a Single-Center Analysis

Session: Comunicações Orais - Sessão 14 - Choque cardiogénico e suporte circulatório mecânico
Speaker: Marta Leite

Congress: CPC 2024
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: Marta Leite; Mariana Brandão; Daniel Caeiro; Fábio Nunes; Marisa Silva; Pedro Gonçalves Teixeira; Gustavo Pires-Morais; Marta Ponte; Adelaide Dias; Alberto Rodrigues; 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:&nbsp;</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 emerged as a crucial therapy in managing refractory cardiogenic shock, offering both circulatory and oxygenation&nbsp;as bridge to recovery, bridge to transplant, or bridge to decision. It is a salvage intervention in patients with cardiogenic shock despite high rates of complications and mortality.&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">This study aimed to assess the demographics, clinical characteristics, and outcomes of VA-ECMO patients with cardiogenic shock in a tertiary centre.</span></span></p>

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

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">We conducted a retrospective observational study, encompassing patients admitted with cardiogenic shock and treated with VA-ECMO from 2011 to 2023. Key patient data, including demographics, comorbidities, clinical presentation, ECMO-related complications, and outcomes, were extracted from medical records. Summary statistics were employed for data analysis.</span></span></p>

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

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">From January 2011 to October 2023 our cardiac intensive care unit treated a total of 85 patients in VA-ECMO [Table 1]. The mean age was 54.5 &plusmn; 11.9 years-old with male predominance (61.2%). Approximately half of the patients (54.1%) were submitted to VA-ECMO implantation after cardiac arrest and most of them were admitted from the emergency room. Acute coronary syndrome accounted for 47.1% of cardiogenic shock cases, followed by acute decompensated heart failure (12.9%), electrical storm (10.6%), and myocarditis (7.1%).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">The median hospital stay was 11.0 days (range: 0 to 114), with a median of 3.0 days on ECMO support (range: 0 to 52). All VA-ECMO reported in this cohort were percutaneous, with 40% requiring left ventricular unloading techniques. </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">In terms of VA-ECMO-related complications, hematological complications, including anemia and thrombocytopenia necessitating transfusion, were observed in 51.8% of patients, and thromboembolic complications, such as acute limb ischemia, affected 28.2% of patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">Bleeding complications were also notable, with 14.1% experiencing significant vascular access-site bleeding, 17.6% gastrointestinal bleeding, 10.6% airway bleeding, and 2.4% intracerebral hemorrhage. </span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">The 5-day survival rate stood at 67% (95% CI, 0.57-0.78), declining to 41% at 30 days (95% CI, 0.30-0.55). Of the 85 patients, 32 (37.6%) died while on VA-ECMO, and 36 patients (42.4%) were either discharged or underwent heart transplantation.</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">Our single-center experience encompassing over a decade illustrates VA-ECMO&#39;s predominant use in younger patients following acute coronary syndrome or acute heart failure. Despite associated complications, our observed mortality rate, while significant, supports&nbsp;the use of VA-ECMO to rescue patients in such ill-fated clinical conditions.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Verdana,Geneva,sans-serif">This analysis provides a foundational understanding of cohort characteristics and sets the stage for future comparative studies.</span></span></p>