Author + information
- Smita I. Negi1,
- Maan Malahfji2,
- Mladen Sokolovic3,
- Rebecca Torguson4,
- Romain Didier4,
- Igor Gregoric2,
- Pranav Loyalka2,
- Augusto Pichard4,
- Lowell F. Satler4,
- Biswajit O. Kar2 and
- Ron Waksman4
Refractory cardiogenic shock (RCS) in acute myocardial infarction (AMI) is associated with high mortality rates. Impella and intra-aortic balloon pump (IABP) provide only limited left ventricular (LV) support. Veno-arterial Extracorporeal membrane oxygenation (VA-ECMO) and peripheral ventricular assist device, TandemHeart (p-VAD), have been claimed to provide superior LV support. However, limited data exists on the outcomes of VA-ECMO and p-VADs in this specific population. This study aimed to compare VA-ECMO and p-VAD in patients presented with RCS complicated by AMI.
Using prospective registries, we identified patients undergoing VA-ECMO or p-VAD placements for an indication of AMI with RCS. Clinical, procedural and clinical outcomes data were recorded for both groups. A comparative analysis of use of these two devices in AMI was performed.
In the study there were 35 patients who presented with RCS. 16 patients were assigned to VA-ECMO and 19 to p-VAD. Baseline clinical characteristics were similar between the groups except for higher incidence of diabetes (58% vs. 9%, p=0.03) in the p-VAD group. Door to device time was also longer in the p-VAD group. Overall the survival rate in hospital (58% vs.56%, p=0.45) and at 30 days (58% vs. 56%, p=0.3) were similar in both groups. There was no significant difference in the incidence of complications including limb ischemia requiring surgery, significant hemolysis, need for renal replacement therapy, stroke or recurrent myocardial infarction between the two groups. However, there was a higher incidence of ventricular arrhythmias in the VA-ECMO group (16% vs. 50%, p=0.02).
Both VA-ECMO and p-VAD had similar survival and complication rates when used in patients presenting with RCS in AMI. Choice of device in these patients should be based on operator expertise and center's resources.
CORONARY: Hemodynamic Support and Cardiogenic Shock
Cardiogenic shock, Extracorporeal membrane oxygenation, TandemHeart