Introduction VA-ECMO is an upcoming technique in the treatment of cardiogenic shock in patients with STEMI however it increases afterload. IABP in addition to VA-ECMO has been suggested to reduce afterload and increase survival. Methods A multi-center in-hospital registry was kept on all patients undergoing VA-ECMO or VA-ECMO and additional IABP treatment for cardiogenic shock in STEMI. Patients were analyzed for baseline characteristics, coronary anatomy using the SYNTAX score, predicted survival using the SAVE-score, survival, neurological status and complications. Results Between 2011 and 2018 18 patients with STEMI underwent VA-ECMO +/− IABP treatment for cardiogenic shock. The majority was male (78% (14/18)) with a median age of 59 (47–75) years. All patients were in Killip class IV. VA-ECMO alone was performed in 61% (11/18) and VA-ECMO and IABP was performed in 39% (7/18). A cardiac arrest was observed 91% (10/11) of the patients in the VA-ECMO alone group vs 71% (5/7) in the VA-ECMO+IABP group (p=0.52). The VA-ECMO+IABP group had more complex coronary anatomy, i.e. a higher amount of left main (LM) disease, LM + 3 vessel disease, and three vessel disease when compared to the ECMO alone group (ECMO+IABP 87% vs ECMO alone 18% vs p=0.03). The Syntax score was higher in the ECMO+IABP group (ECMO alone 22±14 vs ECMO+IABP 32±13). The SAVE score did not differ between the groups (ECMO alone −5.9±2.4 vs ECMO+IABP −6.1±2.6 p=0.88) and has a predicted survival of 25–35%. Survival in the VA-ECMO+IABP group was 100% (7/7), survival in the VA-ECMO group was 55% (6/11) (p=0.035). Good neurological outcome was achieved in more patients in the ECMO+IABP group (ECMO alone 45% vs ECMO+IABP 100% p=0.037). There was no difference in leg ischemia between the VA-ECMO alone group vs the ECMO+IABP group (27% (2/11) vs 0% (0/7) p=0.55) or in bleeding complications (18% (2/11) vs 43% (3/7) p=0.28) Conclusion VA-ECMO can improve survival in patients with cardiogenic shock due to STEMI even when in cardiac arrest. VA-ECMO in combination with IABP is associated with better outcome than VA-ECMO alone. Funding Acknowledgement Type of funding source: None

IntroductionDespite advances in treatment, infective endocarditis (IE) still ranks amongst the most lethal infectious diseases. We sought to determine prognostic factors in general hospitals in the Netherlands as research in this setting is scarce.ResultsBetween 2004 and 2011, we identified 216 cases of IE, 30.1 % of which were prosthetic valve IE. This leads to an annual incidence of IE of 5.7 new cases per 100,000 persons per year. Women were less likely to undergo surgical intervention (OR = 1.96, 95 % CI 1.06–3.61, p = 0.031). Also, ageing was an independent prognostic factor for not receiving surgery in a multivariate analysis (annual OR = 1.04, 95 % CI 1.02–1.06, p < 0.001). Female sex was a prognostic factor for mortality (OR = 2.35, 95 % CI 1.29–4.28, p = 0.005). Age was also an independent prognostic factor for mortality (OR = 1.05, 95% CI 1.03–1.08, p < 0.001). Conservative treatment was a prognostic factor for mortality (OR = 3.39, 95 % CI 1.80–6.38, p < 0.001) whereas surgical intervention was an independent prognostic factor for adverse events (OR = 3.03, 95% CI 1.64–5.55, p < 0.001). Staphylococcus aureus was an independent prognostic factor for adverse events (OR = 2.05, 95 % CI 1.10–3.84, p = 0.024) but not for mortality.ConclusionThis study shows that endocarditis in general hospitals has a high rate of morbidity and mortality. Even when treated, it ranks as one of the most lethal infectious diseases in the Netherlands, especially in women and the elderly.