Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning

Abstract

ObjectiveExtracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. DesignA single-center, retrospective cohort study was carried out. SettingThe cardiovascular ICU of a tertiary hospital. PatientsForty-six patients consecutively subjected to VA-ECMO over 6 years. InterventionsHospital mortality after weaning from ECMO and overall survival (OS) were analyzed. ResultsFifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5–15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (p=0.001), SAPS II score (p=0.009), cannulation bleeding (p=0.01) and post-acute myocardial infarction RCS (p=0.001). After a median follow-up of 27 months (IQR: 11–49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (p=0.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. ConclusionsIn our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.