Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock

Shan P Modi; Yeahwa Hong; McKenzie M Sicke; Nicholas R Hess; Wyatt J Klass; Luke A Ziegler; Ryan M Rivosecchi; Gavin W Hickey; David J Kaczorowski; Raj Ramanan

doi:10.1016/j.xjon.2023.12.005

Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock

JTCVS Open. 2023 Dec 21:17:152-161. doi: 10.1016/j.xjon.2023.12.005. eCollection 2024 Feb.

Authors

Affiliations

¹ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
² Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
³ School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁴ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁵ Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁶ Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pa.
⁷ Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Abstract

Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with concomitant percutaneous microaxial left ventricular assist device support is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with this support strategy have not been well described.

Methods: This study was a retrospective, single-center analysis of patients with CS due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support from December 2020 to January 2023.

Results: A total of 44 patients were included (AMI-CS, n = 20, and ADHF-CS, n = 24). Patients with AMI-CS and ADHF-CS had similar survival at 90 days postdischarge (P = .267) with similar destinations after support (P = .220). Patients with AMI-CS initially supported with VA-ECMO were less likely to survive 90 days postdischarge (P = .038) when compared with other cohorts. Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (P =.013; P = .030). Subanalysis of ADHF-CS patients into acute-on-chronic decompensated HF and de novo HF demonstrated no difference in survival or destination.

Conclusions: VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS with this support strategy. AMI-CS patients with initial VA-ECMO support have increased mortality in comparison to other cohorts. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with this support strategy.

Keywords: ADHF-CS; AMI-CS; VA-ECMO; cardiogenic; pVAD; shock.