SPC365

ECMO-related vascular complications: a single-center experience in a Portuguese tertiary hospital

Session: Sessão de Posters 47 - TAVI
Speaker: Maria Rita Giestas Lima

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Maria Rita Giestas Lima; Daniel A. Gomes; Ana Rita Bello; João Presume; Catarina Brízido; Christopher Strong; António Tralhão
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Vascular complications, whether ischemic or haemorrhagic, remain a major source of morbidity during femoro-femoral (FF) VA-ECMO and may ultimately lead to increased mortality. Underlying mechanisms are possibly related to patient comorbidities, large bore cannulas and concomitant medical therapy, namely antithrombotic and vasoactive drugs. Therefore, a better knowledge of clinical predictors could reduce their overall burden. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">To perform a descriptive analysis of vascular complications in patients supported with FF VA-ECMO implantation and assess its predictors.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Single-center retrospective study including all consecutive patients with cardiogenic shock submitted to VA-ECMO implantation from 01/2015-11/2023. Demographics, clinical, analytical,&nbsp;technical features and&nbsp;vasoactive support used were described. Anticoagulation type and adequate on-target levels (local protocol) during the ECMO-run were reported. Vascular complications included ischemic complications (acute limb ischemia, intestinal ischemia and ischemic stroke); and haemorrhagic complications (defined according to the VARC-3 consortium classification as major, life-threatening or leading to death). Independent predictors of each complication were analysed through multivariate logistic regression.&nbsp;</span></span><span style="font-family:&quot;Times New Roman&quot;,serif">Prognostic effect of vascular complications was evaluated using Cox regression analysis.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">A total of 79 patients underwent VA-ECMO cannulation &ndash; 61 (77%) male, mean age of 53&plusmn;15 years. 73 (92%) patients were cannulated at our hospital, 15 (19%) during cardiopulmonary resuscitation. A distal reperfusion cannula was placed in 55 (70%) patients. The mean time on VA-ECMO was 8&plusmn;7 days&nbsp;and 41 (52%)&nbsp;patients died before decannulation. 30-day mortality was 54% (n=43). VA-ECMO-related vascular complications occurred in 54 (68%) patients: 25 (32%) had&nbsp;ischemic and 42 (53%) haemorrhagic complication; 13 (17%) had both. Patients with ischemic complications had a higher prevalence of peripheral artery disease (8% vs 0%, p=0.034) and cerebrovascular disease (12% vs 0%, p=0.009). Anticoagulation was on target in two-thirds of patients with any vascular complication (Table 1). The number of vasopressor drugs used was similar between those with or without each type of vascular complication. In multivariate analysis, only smoking (adjusted OR 3.77, [1.22&ndash;11.67], p=0.021) predicted ischemic complications. The use of anticoagulation pre-ECMO was the only predictor of haemorrhagic complications (OR 2.60, [1.00&ndash;6.70], p=0.048). Despite their high prevalence, neither type of vascular complication was associated with increased mortality at 30-days (Table 2).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Vascular complications are common in patients under VA-ECMO and difficult to predict. Patient selection and anticoagulation optimization before cannulation may help reduce their clinical impact. </span></span></span></p>