Mid-term Outcomes with the Use of Extracorporeal Membrane Oxygenation for Cardiogenic Shock; Initial Single Center Experience
Cassandra Soto, Deep Vakil, Zoee D'Costa, Sivaveera Kandasamy, Hirohisa Ikegami, Mark J. Russo, Leonard Lee, Anthony Lemaire
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
OBJECTIVE: Cardiogenic shock and cardiac arrests are associated with high mortality rates. VA ECMO and eCPR provide viable options when medical therapy fails. The purpose of this study is to determine the outcomes of VA ECMO and eCPR in patients that require emergent cardiac support.
METHODS: A retrospective chart review of prospectively collected data was performed at an institution from January 1st, 2018 to June 30th, 2020. All consecutive patients who required VA ECMO were evaluated. The study variables included length of stay (LOS), complications, and survival to discharge.
RESULTS: A total of 90 patients were placed on VA ECMO with 44.4% (n=40) of these patients undergoing eCPR and placement on ECMO. A majority of the patients were male (n=64, 71.1%) and the mean age was 58.8 ± 15.8 years. 44.4% of patients were transferred from outside hospitals and 37.8% of patients required additional therapy such as an Impella. The complications were bleeding (n=41, 45.6%), infections (n=11, 12.2%), limb ischemia (n=13, 14.4%), and cerebral vascular accident (n=4, 4.4%). The LOS was significantly longer for patients on VA ECMO compared with eCPR (32.1±40.7 days vs. 17.7±18.2 days). Mean time on VA ECMO was 8.1±8.3 days. Survival to discharge was significantly higher in VA ECMO patients (n=23, 46% vs. n=8, 20% p=0.0087).
CONCLUSIONS: VA ECMO provided an effective rescue therapy in patients in cardiogenic shock with a survival greater than the expected ELSO guidelines of 40%. Survival of eCPR was lower than expected, this emphasizes the importance of careful patient selection.
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