Use of Veno-Arterial Extracorporeal Life Support (VA ECLS) in Awake Patients in Refractory Cardiogenic Shock

Abstract

<h3>Purpose</h3> Avoidance of intubation and use of VA ECLS in awake patients may be beneficial. This study sought to demonstrate safety and feasibility of VA ECLS in non-intubated awake patients. <h3>Methods</h3> This was a retrospective review of VA ECLS patients at our institution from 2017 to 2021 not undergoing ECPR and not cannulated for postcardiotomy shock. Patients were divided into intubated and awake/not ventilated at time of cannulation. Patients' baseline characteristics were analyzed, and propensity score matching was used to compare the complications and outcomes of intubated and awake patients. <h3>Results</h3> Of the 140 patients included in the study, 103 (74%) were intubated, whereas 37 (26%) were awake at time of cannulation. All awake patients underwent percutaneous femoral cannulation and technical success was 100%. Overall, 45 (32%) were female, average age was 56.2±13.5 years, and average body mass index was 30.0±7.4. In the initial cohort, there were no significant differences between intubated and awake patients with respect to demographics and comorbidities. However, awake cohort was most likely to be in acute decompensated heart failure as etiology of shock (51% vs 19%), to be in SCAI D (70% vs 31%), and to have IABP prior to ECLS (59% vs 24%). In the propensity-matched cohort (37 in each group), there were no significant differences in duration of ECLS, stroke, bleeding, need for renal replacement therapy, need for left ventricular unloading or survival to discharge (73% vs 68%). Most common destination post ECLS in intubated patients was recovery (59% vs 24%), as opposed to ventricular assist device implantation (38% vs 2.7%) or transplantation (24% vs 5.4%) in awake patients (p<0.001). <h3>Conclusion</h3> In the largest retrospective series to date of awake VA ECLS, its use is safe, feasible and effective in select cardiogenic shock patients especially as a bridge to heart replacement therapies.