Escalation From Intra-Aortic Balloon Pump to Extracorporeal Membrane Oxygenation may be Associated With Poor Outcomes in Patients With Cardiogenic Shock.

BACKGROUND & AIM: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used for refractory cardiogenic shock (CS). Although guidelines have downgraded the recommendations for intra-aortic balloon pump (IABP) in CS, escalation from IABP to ECMO (IABP-ECMO) remains common in patients with CS. This study aims to determine the association between IABP-ECMO and outcomes for patients undergoing VA-ECMO.

METHOD: Adults who received IABP before VA-ECMO (IABP-ECMO group) or did not receive IABP before ECMO (direct ECMO group) from 1 January 2017, through 31 August 2022 were extracted from the Chinese Extracorporeal Life Support (CSECLS) registry. The primary outcome was in-hospital mortality.

RESULTS

Among 4,607 patients meeting study inclusion, 655 (14.2%) received IABP before VA-ECMO. Patients in the IABP-ECMO group were older (age 61 vs 55 years), were more likely to have acute myocardial infarction (68.7% vs 39.1%), and were less likely to have cardiac arrest before ECMO (25.8% vs 41.4%) (all p<0.001). In-hospital mortality (57.1% vs 51.4 %; p=0.007) occurred more frequently in the IABP-ECMO group which persisted in multivariable modelling (adjusted odds ratio [aOR] 1,34; 95% confidence interval [CI] 1.08-1.67; p=0.008). Escalation from IABP to ECMO was also associated with on-support mortality (aOR 1.50; 95% CI 1.19-1.88; p=0.001) and limb ischaemia (adjusted OR 2.20; 95% CI 1.62-2.99; p<0.001).

CONCLUSIONS

Among adults receiving VA-ECMO, escalation from IABP to ECMO may be associated with poor in-hospital outcomes.