Similar Outcomes for Medical Patients Supported with VA-ECMO in the Cardiac Care Unit and Cardiac Surgical Intensive Care Unit

Abstract

Background Surgical patients with postcardiotomy cardiogenic shock have been supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the cardiac surgical intensive care unit (CSICU). As a result, CSICUs have developed expertise in caring for VA-ECMO patients. Non-surgical patients are increasingly being supported with VA-ECMO in the cardiac care unit (CCU). It is unclear how the outcomes of patients on VA-ECMO managed in the CCU compare to those managed in the CSICU. Methods We performed a retrospective study of consecutive non-surgical patients between November 2013 and January 2018 who were placed on VA-ECMO and admitted to either the CSICU or CCU. Postcardiotomy shock and primary graft failure patients were excluded. During this time period, patients on VA-ECMO were admitted to either unit in our hospital. Data on demographics, outcomes, and length of stay (LOS) were collected through chart review. Results There were 76 patients included in the study; 52 were managed in the CSICU and 24 were managed in the CCU. Mean age was 55 +/- 5 years and there were no significant differences in baseline demographics. Indications for VA-ECMO included acute myocardial infarction with cardiogenic shock (42.3% in CSICU vs 41.7% in CCU, p=0.96), acute on chronic heart failure (28.8% in CSICU vs 45.8% in CCU, p=0.15) and cardiac arrest (44.2% in CSICU and 41.7% in CCU, p=0.83). There were no significant differences in outcomes between the two units. Hospital mortality was 63.5% in the CSICU and 58.3% in the CCU (p=0.67). There were no differences in adverse events for the CSICU as compared to the CCU for blood stream infections (9.6% vs 4.2%, p=0.41), stroke (19.2% vs 20.8%, p=0.87), and limb ischemia (11.5% vs 20.8%, p=0.28). Patients in both units required similar numbers of blood transfusions (7.4 +/- 2.1 vs 5.0 +/1.9 packed red blood cells, p=0.17). The mean duration of VA-ECMO support was 141 +/- 30 hours in the CSICU versus 115 +/- 32 hours in the CCU (p=0.29). LOS in the CSICU was 22 +/- 5 days versus 20 +/- 8 days in the CCU (p=0.72). Conclusion There were no outcome differences between medical patients on VA-ECMO managed in the CCU and those managed in the CSICU. This suggests that as VA-ECMO use increases and expands, it is possible for these patients to be cared for safely and effectively in the CCU.