TCT-302 Feasibility and Outcomes of a Cardiology-Based Extracorporeal Membrane Oxygenation Service

Document Type

Conference Proceeding

Publication Date

9-7-2023

Publication Title

J Am Coll Cardiol

Keywords

lactic acid, acute heart infarction, adult, artery injury, bleeding, blood transfusion, cannulation, cardiac surgeon, cardiogenic shock, cardiologist, cerebrovascular accident, compartment syndrome, complication, conference abstract, decannulation, extracorporeal oxygenation, female, heart catheterization, heart failure, hemodynamics, human, intensivist, lactate blood level, male, retrospective study, Sequential Organ Failure Assessment Score, tertiary care center, therapy, veno-arterial ECMO

Abstract

Background: There has been a significant increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). ECMO programs have typically been led by cardiothoracic surgery teams, and there is little evidence on alternative care models. Methods: We performed a retrospective analysis of patients treated with peripheral VA-ECMO at a tertiary care center from 2018 to 2022. The primary outcome was death while on ECMO or within 24 hours of decannulation. Results: A total of 244 patients were included in the analysis (median age 61 years; 28.7% female). Interventional cardiologists performed 91.8% of cannulations, and 84.4% of patients were managed primarily by a cardiology service comprising interventional cardiologists, cardiac intensivists, or advanced heart failure cardiologists. The most common indications for ECMO were acute myocardial infarction (34.8%), decompensated heart failure (30.3%), and refractory VT/VF (10.2%). ECMO was utilized for peri-procedural arrest in 26.6% of patients. The median (IQR) pre-ECMO SAVE score was 0.0 (–4.0 to 3.0), and median (IQR) SOFA score was 13.0 (10.0 to 16.0). Forty-six percent of patients survived through decannulation; the majority of patients were decannulated percutaneously in the cardiac catheterization laboratory. There was no difference in survival following cannulation by a cardiac surgeon vs cardiologist (50% vs 45%; P = 0.90). Complications included arterial injury (3.7%), compartment syndrome (4.1%), cannulation site infection (1.2%), stroke (14.8%), AKI (52.5%), dialysis (22.5%), access site bleeding (16%), and need for blood transfusion (83.2%). Positive independent predictors of death while on ECMO or within 24 hours of decannulation included elevated initial serum lactate (OR per mmol/L increase: 1.13; 95% CI: 1.04-1.23; P < 0.01) and SOFA score (OR per 1 unit increase: 1.27; 95% CI: 1.15-1.40; P < 0.01), while SAVE score (OR per 1 unit increase: 0.92; 95% CI: 0.86-0.99; P = 0.03) and 8-hour lactate clearance (OR per % decrease: 0.98; 95% CI: 0.97-0.99; P < 0.01) were negative predictors of this outcome. Conclusion: The use of a cardiology-based ECMO service is feasible. As ECMO services and indications expand, the use of cardiology-based ECMO care may be practical for select centers. Categories: CORONARY: Hemodynamic Support and Cardiogenic Shock

Volume

82

Issue

17

First Page

B120

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