Upgrading of ECLS (ECMO versus STCF-VAD): Is It a Matter of Time?

Abstract

Purpose ECMO for the treatment of refractory cardiogenic shock (RCS) has demonstrated dubious results after 9 days of support. Short-term continuous-flow ventricular assist devices (STCF-VADs) could represent a more physiological choice. We therefore evaluate the outcome of patients that needed prolonged support and underwent STCF-VAD implantation compared to conventional ECMO. Methods Between January 2009 and December 2017, 196 extracorporeal life support (ECLS) were implanted in our centre for primary RCS; we selected the 106 patients that exceed the 9 days of ECLS. 45 cases (42%) were treated exclusively with ECMO implantation (Group 1), while 61 cases (58%) underwent left ventricular or biventricular continuous-flow ventricular assist device STCF-VAD implantation (Group 2). Among these last patients, in 44 cases the STCF-VAD was intended as upgrade of ECMO support. Results The duration of ECLS was 17±9 days in the Group 1 and 14±9 days in the Group 2 (p=0.07), while the mean rates of the maximal theoretic flow were 62±15% and 81±21% (p Conclusion In the purview of prolonged ECLS and full hemodynamic support, STCF-VAD has proved to enhance the early survival respect single-stage ECMO in patients with primary RCS.