NYMC Faculty Publications

Peripheral Venoarterial Extracorporeal Membrane Oxygenation in Combination With Intra-Aortic Balloon Counterpulsation in Patients With Cardiovascular Compromise

Author Type(s)

Faculty

DOI

10.1159/000365138

Journal Title

Cardiology

First Page

137

Last Page

143

Document Type

Article

Publication Date

1-1-2014

Department

Medicine

Keywords

Adult, Aged, Body Mass Index, Cardiomyopathies, Critical Care, Extracorporeal Membrane Oxygenation, Female, Heart Transplantation, Heart-Assist Devices, Hospital Mortality, Humans, Inpatients, Intra-Aortic Balloon Pumping, Length of Stay, Male, Middle Aged, Retrospective Studies, Risk Assessment, Risk Factors, Treatment Outcome, United States

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVES: Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'.

METHODS: We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator.

RESULTS: V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury.

CONCLUSIONS: Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population.

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