TCT-302 Feasibility and Outcomes of a Cardiology-Based Extracorporeal Membrane Oxygenation Service
Recommended Citation
Fadel R, Almajed M, Parsons A, Kalsi J, Shadid AA, Maki M, Jones C, Williams C, Aronow H, Tanaka D, Nemeh H, Fuller B, Alqarqaz M, Koenig G, Villablanca P, Frisoli T, O’Neill BP, Khandelwal A, Cowger JA, Grafton G, Kim HE, O’Neill WW, Alaswad K, Basir MB. TCT-302 Feasibility and Outcomes of a Cardiology-Based Extracorporeal Membrane Oxygenation Service. J Am Coll Cardiol 2023; 82(17):B120.
Document Type
Conference Proceeding
Publication Date
9-7-2023
Publication Title
J Am Coll Cardiol
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
