Abstract
Extra-corporeal membranous oxygenation (ECMO) has been applied in patients with cardiopulmonary failure. One critical drawback of peripheral ECMO is an increase in left ventricular (LV) afterload which could be counterbalanced by the combination of intra-aortic balloon counter-pulsation (IABP) therapy. We hypothesized that an add-on therapy with IABP could improve outcomes in patients receiving ECMO support. We included patients (>18 years old) from 2002 to 2013 requiring ECMO support due to cardiogenic shock in a medical center. A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included. The mortality rates at 2 weeks (48.5 vs. 47.7%) after ECMO implantation were not different between the two groups (ECMO vs. combined group). After adjustment for propensity score and potential confounders, the odds ratios of outcomes within 14 days (combined group vs. ECMO) for poor LV systolic function, high preload, multi-organ failure and mortality were not different. The results remained similar for subgroup analysis. Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes in patients with circulatory failure.
Highlights
Evolved from the 1970s, extra-corporeal membranous oxygenation (ECMO) has been widely used to support patients with respiratory or circulatory failure[1] and a successful bridge for severe heart failure patients to ventricular assistant device (VAD) or transplantation due to various etiologies such as myocardial infarction[2,3], dilated cardiomyopathy[4], myocarditis[5], cardiac surgery complications[6], or cardiac arrest[7]
Fifty-seven patients were excluded since the timings of implanting Extra-corporeal membranous oxygenation (ECMO) and intra-aortic balloon counter-pulsation (IABP) were more than 24 hours and died in 24 hours in combined treatment group
After adjustment for potential confounders, the odds ratios of combined group vs. ECMO were 0.730 for poor left ventricular (LV) systolic function (LVEF ≦ 35%), 0.775 for high preload (CVP), 1.360 for multi-organ failure, 1.008 for mortality at 2 weeks respectively
Summary
Evolved from the 1970s, extra-corporeal membranous oxygenation (ECMO) has been widely used to support patients with respiratory or circulatory failure[1] and a successful bridge for severe heart failure patients to ventricular assistant device (VAD) or transplantation due to various etiologies such as myocardial infarction[2,3], dilated cardiomyopathy[4], myocarditis[5], cardiac surgery complications[6], or cardiac arrest[7]. Intra-aortic balloon counter-pulsation (IABP), another standardized mechanical circulatory support, is considered to improve coronary perfusion, increase LV stroke volume, decrease LV wall stress and myocardial oxygen demand. Some studies have demonstrated that combing IABP in an ECMO-supported patient for cardiogenic shock seems to be an effective mechanical circulatory support modality[8,9] and might potentially prevent the ECMO associated lung edema by reducing pulmonary artery pressure with acceptable complication rate[10]. These reports are small series and lack of control. We planned to investigate whether the combination therapy with IABP and ECMO is superior to ECMO alone in improving outcomes in critically ill patients requiring V-A ECMO rescue
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