Central versus peripheral VA ECMO for cardiogenic shock: an 8-year experience of a tertiary cardiac surgery center in Greece.

Abstract

Background: VA ECMO has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols and its use is rising worldwide in the last decade. Although experience and availability are growing, outcomes remain poor. There is need for evidence to ameliorate clinical practice and improve outcomes.

Methods: We retrospectively reviewed the medical records of all patients who were supported with VA ECMO for cardiogenic shock at our institution between January 2015 and January 2023. The study purpose was to compare outcomes between patients who were supported with central versus peripheral configuration.

Results: ECMO was applied in 108 patients of whom central configuration in 48 (44%) and peripheral in 60 (56%). Patients supported with central VA ECMO were more likely to be supported for post cardiotomy shock [OR 4.6 (CI 95% 2.03 - 10.41)], while patients in the peripheral group for chronic heart failure decompensation [OR 9.4 (CI 95% 1.16 - 76.3]. Central VA ECMO had worse survival during ECMO support (29.2% vs 51.7%, p=0.018) and at discharge (8% vs 37%, p=0.001). These patients were at high risk of complications, such as acute kidney injury (AKI), [OR 2.37 (CI 95% 1.06 - 5.3), p = 0.034] and major bleeding [OR 3.08 (CI 95% 1.36 - 6.94), p<0.001].

Conclusions: Patients on central VA ECMO were supported mainly for post cardiotomy shock, presented with more complications such as major bleeding and AKI and had worse survival to hospital discharge, compared with patients on peripheral VA ECMO. Patient selection, timing of implementation, cannulation strategy and configuration remain main determinants of clinical outcome.