Central versus peripheral VA ECMO for cardiogenic shock: an 8-year experience of a tertiary cardiac surgery center in Greece

Venoarterial extracorporeal membrane oxygenation (VA ECMO) has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols, and its use has been rising worldwide in the last decade. Although experience and availability are growing, outcomes re...

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Published in:	Hellenic journal of cardiology
Main Authors:	Antonopoulos, Michael, Koliopoulou, Antigone, Elaiopoulos, Dimitrios, Kolovou, Kyriaki, Doubou, Dimitra, Smyrli, Anna, Zavaropoulos, Prodromos, Kogerakis, Nektarios, Fragoulis, Sokratis, Perreas, Konstantinos, Stavridis, Georgios, Adamopoulos, Stamatis, Chamogeorgakis, Themistocles, Dimopoulos, Stavros, Soulele, Theodora, Vlahodimitris, Ioannis, Pitsolis, Thodoris, Panoutsopoulou, Maria, Lyberopoulou, Efterpi, Papadopoulos, Kyrillos, Kriaras, Ioannis, Kolonia, Konstantina, Kostantinou, Giorgos, Chronaki, Maria, Tzatzaki, Eleni, Kinti, Charalambia, Prasinou, Effrosini, Mathioudaki, Sophia, Avgerinou, Ioanna, Kossivas, Panagiotis, Panagiotou, Chryssa, Poulis, Dimitrios, Ntinopoulos, Athanasios, Mpardakos, Ioannis, Maraki, Pigi, Nenekidis, Ioannis, Kapelios, Chris, Bonios, Michael J., Leontiadis, Evangelos, Gkouziouta, Aggeliki, Ieromonachos, Konstantinos, Antoniou, Theofani
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 30-09-2024
Subjects:	Cardiac surgery Cardiogenic shock Critical care Mechanical circulatory support VA ECMO ECPR PCS VIS RVF IABP Critical care LVEF Cardiac surgery LVAD FFP RRT Cardiogenic shock pRBC PLT AKI BMI ECMO BiVAD ELSO OR HFPEF CI VA IQR PGD HTx ES CS ACS AAR VA ECMO dCHF Mechanical circulatory support ICU MCS CABG
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Summary:	Venoarterial extracorporeal membrane oxygenation (VA ECMO) has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols, and its use has been rising worldwide in the last decade. Although experience and availability are growing, outcomes remain poor. There is need for evidence to improve clinical practice and outcomes. We retrospectively reviewed the medical records of all patients who were supported with VA ECMO for cardiogenic shock at our institution between January 2015 and January 2023. The study purpose was to compare outcomes between patients who were supported with central versus peripheral configuration. ECMO was applied in 108 patients, 48 (44%) of whom received central configuration and 60 (56%) peripheral. Patients supported with central VA ECMO were more likely to be supported for post-cardiotomy shock (odds ratio [OR] 4.6 [95% confidence interval (CI) 2.03–10.41]), while patients in the peripheral group were predominantly treated for chronic heart failure decompensation (OR 9.4 [95% CI 1.16–76.3]). Central VA ECMO had lower survival rates during ECMO support (29.2% versus 51.7%, p = 0.018) and at discharge (8% versus 37%, p = 0.001). These patients were at high risk of complications, such as acute kidney injury (AKI) (OR 2.37 [95% CI 1.06–5.3], p = 0.034) and major bleeding (OR 3.08 [95% CI 1.36–6.94], p < 0.001). Patients on central VA ECMO were supported mainly for post-cardiotomy shock, presented with more complications such as major bleeding and AKI, and had worse survival to hospital discharge compared with patients on peripheral VA ECMO. Patient selection, timing of implementation, cannulation strategy, and configuration remain the main determinants of clinical outcome. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1109-9666 2241-5955 2241-5955
DOI:	10.1016/j.hjc.2024.09.006