CRT-600.08 Contemporary Trends of Utilization of VA-ECMO Support With and Without Impella or Intra-Aortic Balloon Pump for Cardiogenic Shock in the United States 2016 to 2018

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Background: Secondary mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP) and Impella are postulated to counteract left ventricular afterload from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Trial and outcomes data to support this practice are limited. Methods: Hospitalizations for cardiogenic shock and VA-ECMO from 2016 to 2018 were identified from the National Inpatient Sample. Poisson regression evaluated trends in utilization semiannually. Multivariable logistic and general linear regression evaluated associations of second MCS device use with in-hospital mortality, discharge disposition, and length of stay. Results: Overall, 460,040 hospitalizations (unweighted 92,008) were identified; 12,035 (3%) underwent VA-ECMO, of which 3,115 (26%) also received IABP and 1,880 (16%) Impella. Utilization of Impella with VA-ECMO substantially increased from 2016-2018 (10% to 18%, p<0.001) while use of IABP modestly increased (25% to 26%, p<0.001). In-hospital mortality declined over the course of the study for all groups. A majority 2,280 (57%) second MCS devices were placed on the same day as VA-ECMO; 1,190 (29%) were placed ≥1 day prior and 565 (14%) were placed ≥1 day after. After adjustment, there were no differences in mortality or length of stay with use of IABP or Impella with VA-ECMO compared to VA-ECMO alone, though both decreased odds of skilled nursing facility discharge. Conclusions: From 2016-2018, utilization of Impella and IABP with VA-ECMO significantly increased despite limited trial/guideline support. More than half of Impella and IABP were placed on the same day as VA-ECMO, and the use of a second MCS device did not impact in-hospital mortality or length of stay. Further studies are needed to decipher optimal timing and patient selection to improve outcomes in this population. [Formula presented]

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