TCT-460 Left Atrial Venoarterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO) Compared to Combination VA-ECMO and Impella (ECPELLA) in the Management of Acute Myocardial Infarction Cardiogenic Shock (AMI-CS)
Recommended Citation
Fadel R, Villablanca P, Giustino G, Engel Gonzalez P, O’Neill B, Frisoli T, Basir MB, Cowger J, Shelters R, Lee J, Aurora L, Michaels A, Alaswad K, O’Neill W. TCT-460 Left Atrial Venoarterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO) Compared to Combination VA-ECMO and Impella (ECPELLA) in the Management of Acute Myocardial Infarction Cardiogenic Shock (AMI-CS). J Am Coll Cardiol 2024; 84(18):B145.
Document Type
Conference Proceeding
Publication Date
10-29-2024
Publication Title
J Am Coll Cardiol
Abstract
Background: Left ventricular (LV) unloading is associated with improved mortality among patients with cardiogenic shock on venoarterial extracorporeal membrane oxygenation (VA-ECMO). There is a paucity of data comparing mechanical support devices, particularly percutaneous cannulation strategies. Methods: We performed a retrospective analysis of patients with acute myocardial infarction–related cardiogenic shock (AMI-CS) on VA-ECMO from 2018 to 2023 at a quarternary care center. Patients were divided based on index cannulation strategy. Complications related to extracorporeal membrane oxygenation (ECMO) and mortality outcomes were analyzed. Results: Seventy patients were analyzed; 20 (29%) were treated with left atrial venoarterial ECMO, and 50 (71%) were treated with combination VA-ECMO plus Impella (Abiomed) (ECPELLA). Baseline demographics including age, sex, race, body mass index, and medical history as well as baseline lactate levels and Society of Cardiovascular Angiography and Interventions shock stage at the time of cannulation were similar. Hemodynamic effects of both strategies (Figure) were similar. Patients treated with ECPELLA experienced more access site bleeding (34.0% vs 10.0%; P = 0.042) and received more blood transfusions (90.0% vs 60.0%; P = 0.003). Incidence of limb ischemia and stroke were higher among patients with ECPELLA but did not meet statistical significance. Thirty-day survival from cannulation was similar between the 2 groups. [Formula presented] Conclusion: Left atrial venoarterial ECMO demonstrates a similar hemodynamic profile compared to ECPELLA among patients with AMI-CS, with lower rates of access site bleeding and blood transfusions. Future studies comparing these treatment modalities are warranted. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest.
Volume
84
Issue
18
First Page
B145
