Venoarterial ECMO in cardiogenic shock: a decade-long single-center analysis
Authors: Leite M , Brandao M , Nunes F , Neves A , Silva M , Ponte M , Dias A , Teixeira P , Pires-Morais G , Caeiro D , Fontes-Carvalho R 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has emerged as a salvage intervention in refractory cardiogenic shock, offering both circulatory and respiratory support as a bridge to recovery, a bridge to transplant, or a bridge to decision.

Purpose
This study aimed to assess the demographics, clinical characteristics, and outcomes of VA-ECMO patients with cardiogenic shock in a tertiary center.

Methods
We conducted a retrospective observational study, encompassing patients admitted with cardiogenic shock and treated with VA-ECMO up to October 2023, marking the milestone of the 100th VA-ECMO patient in our unit. Key patient data, including demographics, clinical presentation, ECMO-related complications, and outcomes, were extracted from medical records. Summary statistics were employed for data analysis.

Results
From 2012 to October 2023, our hospital treated 100 patients in VA-ECMO. The mean age was 58.4 ± 11.9 years, with a male predominance (60%). Approximately 50% of patients were admitted from the emergency room after sudden cardiac arrest. Acute coronary syndrome (ACS) accounted for 39% of cardiogenic shock cases, followed by complicated post-valvular replacement surgery (13%), myocarditis (10%), and acute decompensated heart failure (9%).
The median hospital stay was 12.5 days (range: 0 to 114), with a median of 4.0 days on ECMO (range: 0 to 52). All VA-ECMO reported in this cohort were percutaneous, with 39% requiring left ventricular unloading. In 11% cases VA-ECMO served as a bridge to transplant.
When it comes to VA-ECMO-related complications, hematological complications, including anemia and thrombocytopenia necessitating transfusion, were observed in 53% of patients, and thromboembolic complications, such as acute limb ischemia, affected 28% of patients. Bleeding complications were notable, with 12% experiencing significant access bleeding, 16% gastrointestinal bleeding, 9% airway bleeding, and 2% intracerebral hemorrhage. Additionally, 39% necessitated renal replacement therapy due to acute kidney failure.
The 5-day survival rate stood at 69% (95% CI, 0.61-0.79), declining to 36% at 30 days (95% CI, 0.27-0.48) (see Figure 1). Of the 100 patients, 41 died while on VA-ECMO, with 36 either discharged or undergoing transplantation.

Conclusions
Our single-center experience illustrates VA-ECMO's predominant use in younger patients following ACS or cardiothoracic surgery. Despite associated complications, particularly thromboembolic events and severe bleeding, our observed mortality rate is slightly lower than reported for refractory cardiogenic shock. New research has emerged from global VA-ECMO registries, as well as clinical trials, however real-world data is lacking. This analysis provides a foundational understanding of cohort characteristics and sets the stage for future comparative studies.Table 1.Patient CharacteristicsFigure 1.Surviving Curve