Journal of cardiothoracic and vascular anesthesia · 2025
Outcomes of Patients Requiring VA-ECMO for Cardiogenic Shock and Evaluation of Programmatic Changes.
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Kidd Brent, Hughes Kimberly, Zorn Tyler, He Jianghua, Kim Jaromme, Whisenhunt Morgan, Flynn Brigid C
Аннотация
OBJECTIVES: To describe outcomes in patients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock and to evaluate outcomes following programmatic changes.
DESIGN: A retrospective cohort study.
SETTING: A tertiary care medical center.
PARTICIPANTS: Patients who experienced cardiogenic shock and required VA-ECMO.
INTERVENTIONS: Patients with cardiogenic shock were placed on VA-ECMO and outcomes were analyzed in two different eras.
MEASUREMENTS AND MAIN RESULTS: From January 2012 to January 2025, 134 adults required VA-ECMO for cardiogenic shock. Survival to discharge in these patients was 50% (n = 73). From January 2020 to January 2025, 46 patients required VA-ECMO for cardiogenic shock, and the overall mortality rate was 23.9%. Characteristics associated with mortality included procedure type (p = 0.025), more blood products (red blood cells, p = 0.037; fresh frozen plasma, p = 0.030; platelets, p = 0.044; cryoprecipitate, p = 0.001), and longer cardiopulmonary bypass time (p = 0.005). Survivors had a significantly longer hospital stay (mean 33.57 days) versus nonsurvivors (mean 12.18 days) (p = 0.001). In the subset of 22 patients undergoing heart transplantation, 20 patients (90.1%) survived.
CONCLUSIONS: This study identifies a current mortality rate for patients with cardiogenic shock requiring VA-ECMO at 23.9%. This rate is lower than previously reported and coincides with beneficial programmatic changes to an ECMO program.
DESIGN: A retrospective cohort study.
SETTING: A tertiary care medical center.
PARTICIPANTS: Patients who experienced cardiogenic shock and required VA-ECMO.
INTERVENTIONS: Patients with cardiogenic shock were placed on VA-ECMO and outcomes were analyzed in two different eras.
MEASUREMENTS AND MAIN RESULTS: From January 2012 to January 2025, 134 adults required VA-ECMO for cardiogenic shock. Survival to discharge in these patients was 50% (n = 73). From January 2020 to January 2025, 46 patients required VA-ECMO for cardiogenic shock, and the overall mortality rate was 23.9%. Characteristics associated with mortality included procedure type (p = 0.025), more blood products (red blood cells, p = 0.037; fresh frozen plasma, p = 0.030; platelets, p = 0.044; cryoprecipitate, p = 0.001), and longer cardiopulmonary bypass time (p = 0.005). Survivors had a significantly longer hospital stay (mean 33.57 days) versus nonsurvivors (mean 12.18 days) (p = 0.001). In the subset of 22 patients undergoing heart transplantation, 20 patients (90.1%) survived.
CONCLUSIONS: This study identifies a current mortality rate for patients with cardiogenic shock requiring VA-ECMO at 23.9%. This rate is lower than previously reported and coincides with beneficial programmatic changes to an ECMO program.