D. Ranney1, B. Yerokun1, J. Meza1, D. Bonadonna1, J. Schroder1, J. Haney1, C. Milano1, M. Daneshmand1 1Duke University Medical Center,Durham, NC, USA
Introduction: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is an adaptation of cardiopulmonary bypass that provides circulatory support during cardiac failure for an extended period of time. The utilization of ECMO in the adult population has continued to increase both nationally and globally, yet outcomes vary widely across institutions. The purpose of this study was to characterize the clinical outcomes of adult patients undergoing VA ECMO support at a single high volume institution.
Methods: A single-center retrospective review was performed of adult patients undergoing ECMO cannulation between January 2009 and December 2014. Demographics, details of ECMO deployment, and incidence of clinical events were acquired from the medical record. Primary outcomes included survival to decannulation and survival to hospital discharge. Standard analysis was performed to depict patient outcomes.
Results: During the study period, 240 adult patients underwent cannulation for ECMO. Of these, 131 were veno-arterial (VA) cannulations, 75 (57.3%) of whom were transferred from outside facilities. Of 131 VA ECMO patients, primary cannulations were via the femoral artery (N=79, 60.3%), axillary artery (N=16, 12.2%), and aorta (N=36, 27.5%). Indications for ECMO included cardiogenic shock (N=122, 93.1%), respiratory failure with hemodynamic instability (N=13, 9.9%), and mixed shock/sepsis (N=4, 3.1%). The most common etiologies of cardiogenic shock were cardiac arrest (N=50), post-cardiotomy cardiogenic shock (N=44), and acute myocardial infarction (N=27). Prior to ECMO, 56 patients had an intra-aortic balloon pump in place. Vascular complications occurred in 29 patients (22.1%), GI complications in 8 patients (6.1%), stroke in 19 (14.5%), clinically significant coagulopathy in 25 (19.1%), cannula site bleeding in 28 (21.4%), new onset dialysis in 19 (14.5%), and dialysis at discharge in 2 of 55 hospital survivors (3.6%). Left ventricular assist devices were placed in 21 patients, and 12 patients underwent heart transplantation. Survival to decannulation was 61.6% and survival to hospital discharge was 43.2%.
Conclusion: Favorable clinical outcomes and survival can be achieved with adult ECMO when performed at a high volume center. Further study will be needed to assess predictors of survival and optimization of patient selection.