Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Abstract

Objectives The aims of this single‐center retrospective study were to characterize and determine predictors of 30‐day survival in a cohort of patients requiring venoarterial extracorporeal membrane oxygenation (VA‐ECMO) supported cardiopulmonary resuscitation (E‐CPR) in the cardiac catheterization laboratory (CCL) for cardiac arrest (CA) or refractory cardiogenic shock (CS). Background While safety in the CCL has improved, periprocedural mortality from CA remains high. The application of VA‐ECMO is an emerging form of resuscitation with a paucity of data evaluating its use in the CCL for CA or CS. Methods All consecutive patients aged 18 years or older presenting to a single CCL from October 2010 to May 2018 who required E‐CPR for CA or refractory CS were included. The primary outcome of our study was overall survival 30 days from VA‐ECMO initiation. Secondary outcomes included 1‐year survival, hospital length of stay, and ECMO related complications. Results Sixty‐two patients with a mean age of 60 ± 9 years, 63% male, were included. VA‐ECMO was initiated for CA in 39 patients (63%) and for CS in 23 patients (37%). The median ECMO duration was 48 hr. Overall 30‐day survival was 47% (CA group 44% vs. CS group 52%; p = .414). One‐year survival was 44%. Initial serum creatinine (OR 1.18 per 10 μmol/L increase; p = .016; AUC = 0.65) was the only multivariate predictor of 30‐day mortality. Conclusions The use of VA‐ECMO in the CCL is feasible, demonstrating 47% 30‐day survival, largely persistent to 1 year, in a cohort that otherwise has extremely high mortality.

Supporting High-Risk Percutaneous Coronary Interventions With Mechanical Devices

“…The European Society of Cardiology’s myocardial revascularization guidelines have a Class IIb recommendation for short-term use of MCS in patients with acute coronary syndromes and unstable hemodynamics ( 3 ). New research is bringing light to its role in supporting high-risk PCI in patients without shock ( 4 , 5 , 6 , 7 ). However, there are no current guideline recommendations for or against MCS in hemodynamically stable patients.…”

Peripheral venoarterial extracorporeal membrane oxygenation for periprocedural Cardiogenic shock during interventional cardiology

“…Prior studies in patients undergoing interventional cardiology procedures have described lower in-hospital survival rates despite implementation of VA-ECMO programs in the CCL. In patients with acute myocardial infarction experiencing refractory CS, several cases series reported survival rates of 22%-65% after peripheral VA-ECMO [11][12][13][14][15][16][17] . In patients suffering hemodynamic complications during TAVR, rescue VA-ECMO support produced in-hospital survival rates of 44%-75% [17][18][19][20] .…”

Clinical Efficacy of ECMO in the Treatment of AMI Complicated with Refractory CS

“…The protocol and indications for discontinuation of ECMO were in accordance with previous descriptions. 15 The time of IABP discontinuation was determined according to the recovery of patients' cardiac function and changes in vital signs.…”