Impact of Veno-Arterial Membrane Oxygenation on Outcome of “Crash and Burn” Patients Transitioned to Durable Left Ventricular Assist Device

Abstract

Purpose To investigate the outcome of patients in refractory cardiogenic shock who required VA ECMO as a bridge to durable LVAD Methods This is a retrospective review of all adult INTERMACS profile 1 patients who underwent LVAD implantation at our institution between 01/01/2015 and 12/31/2017. The outcomes of patients who were bridged with VA ECMO (ECMO group) were compared with those without bridging (non-ECMO group). Results Out of 27 patients, 16 were bridged with VA ECMO. Basic characteristics are presented in Table 1. After the LVAD implantation, patients in the ECMO group experienced more right ventricular failure requiring temporary RVAD (75% vs. 27%, P\u202f=\u202f0.014) and more postoperative surgical bleeding (75% vs. 36%, P\u202f=\u202f0.045). Hospital mortality was 25% in ECMO and 18% in non-ECMO group (P\u202f=\u202f0.675). Of the hospital survivors, 8 were transplanted, 4 recovered, one patient underwent pump exchange and three are still on support. One-year survival for ECMO group was 56 ±18% versus 47 ±20% in non-ECMO group (Figure 1A). Freedom from infection (Figure 1B), neurologic dysfunction (Figure 1C) and device malfunction (Figure 1D) was 47 ±13%, 65 ±20% and 79 ±11% in ECMO group and 44 ±18%, 37 ±22% and 78 ±14% in non-ECMO group. Conclusion Patients in refractory cardiogenic shock have acceptable post LVAD outcome when bridged with percutaneous VA ECMO. Despite significantly higher rate of postoperative surgical bleeding and the need for biventricular support, both overall survival and LVAD-associated complications are comparable to non-ECMO bridged INTERMACS profile 1 LVAD recipients.