Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise.

Abstract

OBJECTIVES:

Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'.

METHODS:

We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator.

RESULTS:

V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury.

CONCLUSIONS:

Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population.

• Authors: Alan Gass, Chandrasekar Palaniswamy, Wilbert S Aronow, Dhaval Kolte, Sahil Khera, Hasan Ahmad, Linda J Cuomo, Robert Timmermans, Martin Cohen, Gilbert H Tang, Masashi Kai, Steven L Lansman, Gregg M Lanier, Ramin Malekan, Julio A Panza, David Spielvogel
• Journal: Cardiology (Cardiology) Vol. 129 Issue 3 Pg. 137-43 ( 2014) ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 25277292 (Publication Type: Journal Article)
• Copyright: © 2014 S. Karger AG, Basel.

Topics

• Adult
• Aged
• Body Mass Index
• Cardiomyopathies (mortality, therapy)
• Critical Care
• Extracorporeal Membrane Oxygenation (adverse effects)
• Female
• Heart Transplantation (methods)
• Heart-Assist Devices
• Hospital Mortality
• Humans
• Inpatients
• Intra-Aortic Balloon Pumping
• Length of Stay
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Treatment Outcome
• United States