Author + information
- Carlos Leon Alviar,
- Alejandra Gutierrez,
- Terence Hill,
- Amar Krishnaswamy,
- Deborah Klein,
- Nader Moazami and
- Venu Menon
Background: Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue tool for refractory cardiogenic shock (RCS) and it has traditionally been placed and managed by cardiothoracic surgeons (CTS). A cardiologist managed (CM) VA-ECMO program is an attractive option to optimize care, minimize delays and costs. We aim to describe our CM VA-ECMO program experience for patients with RCS, managed exclusively in the coronary care unit (CCU).
Methods: A retrospective analysis of patients admitted to the Cleveland Clinic CCU from 2013–15 with RCS and VA-ECMO was performed. Demographic, therapeutic and outcomes data was analyzed.
Results: A total of 34 patients were included. The majority were male (67.6%, N=23), 35.0% (12) had coronary artery disease (CAD), 38.2% (13) had hypertension and 26.5% (9) had chronic heart failure (HF). Interventional cardiology implanted VA-ECMO in 61.8% (21) of cases. The indications were acute coronary syndromes (55.9%; 19), ventricular septal rupture (8.8%; 3), pulmonary embolism (2.9%; 1), myocarditis (5.9%; 2), acute HF (41.2%; 14), tamponade (2.9%;1) and acute valvular disease (2.9%; 1). Cardiac arrest occurred in 58.8% (21), 52.9% (18) underwent coronary intervention, 17% (6) received therapeutic hypothermia. All patients were on vasopressors and mechanical ventilation, 27.3% (9) required renal replacement therapy, 88.2% (30) had adjunctive intra-aortic balloon pump and 12.1% (4) impella (2.5% impella 2.5, 5.2% impella CP, 3.3% impella 5.0). Mortality was 64.7% (22), and withdrawal of care took place in 65%(12) of these. Survivors were younger, had less CAD and hyperlipidemia. Amongst them, referral for advance therapies took place in 33.3% (4) (25.0% for transplant/LVAD and 8.3% for total artificial heart). Decannulation was done in 58.8% (20) and 35.3% (12) were extubated. Cardiology subspecialty consult was needed in 82.4% (28) of cases (26.5% for electrophysiology, 76.5% for heart failure) 5.9% (2) by palliative care. No vascular mishaps were encountered
Conclusions: VA-ECMO management in the CCU with a consultative role of CTS is a feasible and practical option for patients with RCS. This approach could optimize care, minimize delays and costs.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Intervention in Interventional Cardiology: Advanced Device Use
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1155-150
- 2017 American College of Cardiology Foundation