SPC365

Unveiling mortality outcomes in Cardiogenic Shock adult patients with Peripheral Venoarterial Extracorporeal Membrane Oxigenation

Session: Sessão de Posters 04 - Choque cardiogénico
Speaker: Mariana Sousa Paiva

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: Cartazes
FP Number: ---
Authors: Mariana Sousa Paiva; Ana Rita Bello; Catarina Brízido; Maria Rita Lima; Daniel A. Gomes; Francisco Albuquerque; Rita A. Carvalho; Pedro Lopes; João Presume; Christopher Strong; António Tralhão

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:12pt">[Background and aims]:</span></strong></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a temporary advanced circulatory support for patients with or at risk of refractory cardiogenic shock (CS). Although mortality in this setting is understandably high, there is scant information about death patterns after cannulation. Our aim was to describe the timing and causes of in-hospital death of our cohort of adult CS patients supported with VA-ECMO, including those who died after a successful weaning process.</span></span></p>

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<p><strong><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">[Methods]:</span></span></strong></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Single-center retrospective study of all consecutive patients who underwent peripheral VA-ECMO implantation from January 2015 to November 2023 for refractory CS. Patient and procedural variables, VA-ECMO-related complications, in-hospital and 30-day mortality (on ECMO and after weaning) rates, and causes of death were collected from electronic records. </span></span></p>

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<p><strong><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">[Results]:</span></span></strong></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">In total, 75 patients (mean age 53&plusmn;14 years; 76.0% (n=57) male) were included, the majority with a femoro-femoral VA-ECMO configuration (n=72; 96.0%). The most common etiologies of CS were acute myocardial infarction (n=33; 44.0%), acute-on-chronic heart failure (n=15; 20.0%) and acute myocarditis (n=9; 12.0%). Before ECMO cannulation, 28 patients (37.3%) experienced cardiac arrest. At the time of cannulation, the majority of the patients were classified as SCAI class D (n=52; 69.3%), with median SAVE and SAPS II scores of -6 (IQR -11 to -2) and 46 (IQR 38-53), respectively. </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">VA-ECMO-related complications were frequent, with at least one occurring in 59 patients (78.7%). In-hospital mortality during VA-ECMO support stood at 44% (n=33), with a median time to death of 3 days (IQR 1-11) (<span style="color:#0070c0">fig.1A</span>). Primary causes of death on ECMO were refractory shock (n=16, 48.5%), followed by multiple organ failure (n=8, 24.2%) and catastrophic neurological events (n=5, 15.2%) (<span style="color:#0070c0">fig.1C</span>). </span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">After successful weaning, 13 additional patients deceased, with a median time from decannulation to death of 14 days (IQR 3-30) (<span style="color:#0070c0">fig.1B</span>). None fulfilled criteria for a new ECMO-run, 5 patients (38%) had a surgical mechanical circulatory support implanted, but none was candidate to advanced heart failure therapies.</span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">From the remaining 29 patients (39%), 7 (24%) underwent either heart transplant or left ventricular assist device implantation during indexed hospitalization, and all were later discharged.</span></span></p>

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<p><strong><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">[Conclusion]:</span></span></strong></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Over the past 8 years, the mortality rate for patients undergoing peripheral VA-ECMO for CS remained high, replicating results from larger studies. A substantial number of patients died post-successful weaning, underscoring the complexity of this high-risk population. Further research is crucial for refining patient selection, optimizing management, and improving outcomes.</span></span></p>