Central veno-arterial ECMO via an aortic prosthetic graft as significant alternative to peripheral ECMO cannulation: evaluation of patient outcomes in infarct-related cardiogenic shock.

BACKGROUND: For patients presenting with cardiogenic shock due to acute myocardial ischaemia, veno-arterial extracorporeal membrane oxygenation (ECMO) is often the only potential lifesaving intervention remaining when revascularisation does not immediately improve the patient’s condition. A relatively recent cannulation technique involves using an end-to-side prosthetic graft sewn onto the ascending aorta to allow the inflow cannula to be inserted outside the chest. There is no literature on this cannulation method compared to traditional peripheral ECMO. We performed a comprehensive analysis to evaluate the advantages and disadvantages of this technique providing valuable insights into patient outcomes. METHODS: A total of 65 patients suffering from severe, infarct-related cardiogenic shock were supported with ECMO at the University Hospital Magdeburg between 2014 and 2022. The patients were divided into two groups: a central ECMO group of 33 patients and a peripheral ECMO group consisting of 32 patients. We compared the pre-implantation laboratory parameters as well as laboratory parameters on the third day of ECMO, post-implanatation complications, and survival rates in both the groups. RESULTS: The primary outcome of the study was survival. Patients who received central ECMO exhibited a higher 60-day survival rate (54.5%) in comparison to those who received peripheral ECMO (28.1%) (p = 0.031). With regard to secondary outcomes, patients receiving central ECMO exhibited a higher incidence of bleeding events (56.3% versus 84.8%, p = 0.011), along with a greater prevalence of hemothorax (21.9% versus 53.1%, p = 0.013) and mucosal bleeding (12.5% versus 48.5%, p = 0.002). Conversely, patients with peripheral ECMO exhibited a higher incidence of acute leg ischaemia (18.8% vs. 3.0%, p = 0.041). CONCLUSION: The application of central ECMO with a prosthesis on the ascending aorta can effectively support patients experiencing cardiogenic shock due to acute myocardial ischaemia. However, more careful hemostasis is required to minimise bleeding, especially hemothorax.