Long-term prognosis of patients with refractory cardiogenic shock and cardiac arrest treated with venoarterial ECMO in a hospital without on-site cardiac surgery

Abstract

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Regional hospital Liberec Introduction Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical circulatory support increasingly used in the treatment of refractory cardiogenic shock or circulatory arrest. The technique of percutaneous implantation currently allows the use of VA-ECMO even in hospitals without on-site cardiac surgery. Method Analysis of data from a single center prospective registry of patients with refractory cardiogenic shock and cardiac arrest treated with VA-ECMO from May 2015 to September 2022. Results In total 42 patients were implanted. Most of the patients (76%) were men, 63.0 +/- 12.5 years old. 64% of patients fulfilled criteria of stage E of SCAI classification, and 36% were SCAI D. 33% of patients were resuscitated prior to implantation. 31% of patients were implanted during continuous CPR. The most common cause of shock was acute coronary syndrome (64%). In all cases, ECMO was implanted in the catheterization laboratory without any major complications. The most frequent complication during treatment was non-fatal bleeding in 60% of patients. Ischemic and thrombotic complications occurred in 19% of patients. One patient had a fatal complication related to vascular access. Weaning from ECMO was achieved in 55% of all patients. 9 patients were transported to another hospital on ECMO without complications. 38% of patients had simultaneously intra-aortic balloon pump. Two patients were bridged to LVAD. 30-day and 1-year mortality for SCAI D cardiogenic shock was 40% and 60%, respectively. For SCAI E 78% and 83%, respectively. 65% of successfully weaned patients died within 1 year - median 22 days (15 - 52 days). Patients who survive 1 year have a good long-term prognosis - median follow-up 1.2 years (0.8 - 5.4 years). Conclusion Treatment of refractory cardiogenic shock or cardiac arrest with VA-ECMO can be safely initiated, managed and terminated in a hospital without on-site cardiac surgery. The long-term prognosis of most of these patients is serious despite treatment. Patients who survive 1 year have a good long-term prognosis.