Feasibility and Outcomes of a Cardiovascular Medicine Inclusive Extracorporeal Membrane Oxygenation (ECMO) Service

Authors

Raef A. Fadel, Henry Ford HealthFollow
M. Ramzi Almajed, Henry Ford HealthFollow
Austin Parsons, Henry Ford HealthFollow
Jasmeet Kalsi, Henry Ford HealthFollow
Al Muthanna Shadid, Henry Ford HealthFollow
Mohamed Maki, Henry Ford HealthFollow
Mohammad Alqarqaz, Henry Ford HealthFollow
Herbert D. Aronow, Henry Ford HealthFollow
Jennifer A. Cowger, Henry Ford HealthFollow
Brittany S. Fuller, Henry Ford HealthFollow
Tiberio Frisoli, Henry Ford HealthFollow
Gillian Grafton, Henry Ford HealthFollow
Henry Kim, Henry Ford HealthFollow
Crystal D. Jones, Henry Ford HealthFollow
Gerald C. Koenig, Henry Ford HealthFollow
Akshay Khandelwal
Hassan Nemeh, Henry Ford HealthFollow
Brian P. O'Neill, Henry Ford HealthFollow
Daizo Tanaka, Henry Ford HealthFollow
Celeste Williams, Henry Ford HealthFollow
Pedro Villablanca, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow
Khaldoon Alaswad, Henry Ford HealthFollow
Mir B. Basir, Henry Ford HealthFollow

Recommended Citation

Fadel RA, Almajed MR, Parsons A, Kalsi J, Shadid M, Maki M, Alqarqaz M, Aronow H, Cowger J, Fuller B, Frisoli T, Grafton G, Kim H, Jones C, Koenig G, Khandelwal A, Nemeh H, O'Neill B, Tanaka D, Williams C, Villablanca P, O'Neill W, Alaswad K, and Basir MB. Feasibility and Outcomes of a Cardiovascular Medicine Inclusive Extracorporeal Membrane Oxygenation (ECMO) Service. J Soc Cardiovasc Angiogr Interv 2024; 3(6):101359.

Document Type

Article

Publication Date

6-1-2024

Publication Title

J Soc Cardiovasc Angiogr Interv

Abstract

BACKGROUND: There has been a significant increase in the utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in recent years. Cardiothoracic surgery teams have historically led VA-ECMO care teams, with little data available on alternative care models.

METHODS: We performed a retrospective review of a cardiovascular medicine inclusive VA-ECMO service, analyzing patients treated with peripheral VA-ECMO at a large quaternary care center from 2018 to 2022. The primary outcome was death while on VA-ECMO or within 24 hours of decannulation. Univariate and multivariate analyses were used to identify predictors of the primary outcome.

RESULTS: Two hundred forty-four patients were included in the analysis (median age 61 years; 28.7% female), of whom 91.8% were cannulated by interventional cardiologists, and 84.4% were managed by a cardiology service comprised of interventional cardiologists, cardiac intensivists or advanced heart failure cardiologists. Indications for VA-ECMO included acute myocardial infarction (34.8%), decompensated heart failure (30.3%), and refractory cardiac arrest (10.2%). VA-ECMO was utilized during cardiopulmonary resuscitation in 26.6% of cases, 48% of which were peri-procedural arrest. Of the patients, 46% survived to decannulation, the majority of whom were decannulated percutaneously in the cardiac catheterization laboratory. There was no difference in survival following cannulation by a cardiac surgeon vs interventional cardiologist (50% vs 45%; P = .90). Complications included arterial injury (3.7%), compartment syndrome (4.1%), cannulation site infection (1.2%), stroke (14.8%), acute kidney injury (52.5%), access site bleeding (16%) and need for blood transfusion (83.2%). Elevated baseline lactate (odds ratio [OR], 1.13 per unit increase) and sequential organ failure assessment score (OR, 1.27 per unit increase) were independently associated with the primary outcome. Conversely, an elevated baseline survival after VA ECMO score (OR, 0.92 per unit increase) and 8-hour serum lactate clearance (OR, 0.98 per % increase) were independently associated with survival.

CONCLUSIONS: The use of a cardiovascular medicine inclusive ECMO service is feasible and may be practical in select centers as indications for VA-ECMO expand.

PubMed ID

39132589

Volume

3

Issue

6

First Page

101359

Last Page

101359