TCT-308 Cardiogenic Shock–Associated Cardiorenal Syndrome Improves With the Use of Left Atrial Venous Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO)
Eng M, Al-Darzi W, Villablanca P, Frisoli T, Gonzalez PE, Chiang M, Basir M, Cowger J, Alaswad K, Prasad A, and O'Neill W. TCT-308 Cardiogenic Shock–Associated Cardiorenal Syndrome Improves With the Use of Left Atrial Venous Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO). J Am Coll Cardiol 2021; 78(19):B126.
J Am Coll Cardiol
Background: Cardiorenal syndrome (CRS) can complicate cardiogenic shock (CS) in 60% of cases. A strong predictor of CRS is elevated right atrial (RA) pressure. Left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) uses a long fenestrated trans-septal cannula that unloads the left and right atrium simultaneously. We describe the impact of rapidly decompressing RA pressure and improved perfusion on renal function with LAVA-ECMO.
Methods: From July 2020 to August 2021, 15 patients underwent LAVA-ECMO cannulation at Henry Ford Hospital. Patient characteristics, procedural data, and outcomes were analyzed. Variables are expressed as proportions and medians (interquartile range [IQR]). The Wilcoxon signed rank test was used with 95% confidence intervals for comparisons.
Results: The median age was 62 years (IQR: 52-71 years), and 13% were women. Most patients had pure CS (87%) and mixed distributive CS in 2 patients (13%). Most patients had severe valvular heart disease (80%). LAVA-ECMO caused a significant reduction in RA pressure (Figure 1A) and increased pulmonary artery saturation from 48% (IQR: 37-56) to 72% (IQR: 64-81) (P = 0.002). Of the 12 patients not receiving renal replacement therapy, 75% patients experienced improvement in renal function, 2 had no change, and 1 worsened. The distribution of serum creatinine (Cr) is shown in Figure 1B between baseline Cr, day of LAVA-ECMO, 1 day post-LAVA ECMO, and at the time of destination.
Conclusion: LAVA-ECMO lowers RA pressure, improves perfusion, and is associated with rapid reversal of cardiorenal syndrome in most patients. Prospective studies using LAVA-ECMO for cardiogenic shock are warranted.