N. Wall1, J. E. Tonna1, A. Koliopoulou1, K. Stoddard1, S. G. Drakos2, C. H. Selzman1, S. H. McKellar1 1University of Utah,Cardiothoracic Surgery,Salt Lake City, UT, USA 2University Of Utah,Cardiovascular Medicine,Salt Lake City, UT, USA
Introduction:
The time between the onset of cardiogenic shock and initiation of mechanical circulatory support is inversely related to patient survival. The delays inherent to transporting a patient to the operating room (OR) for initiation of extracorporeal membrane oxygenator (ECMO) could prove fatal. A primed and portable VA ECMO system would allow initiation of ECMO in various locations within the hospital, including the emergency department for patients with out of hospital cardiac arrest (OHCA). We hypothesized that an in-hospital, portable VA ECMO program would improve outcomes for patients in cardiogenic shock.
Methods:
We retrospectively reviewed our institutional experience with VA ECMO based on two periods: the first was from the beginning of our VA ECMO program (2009), and the second from initiation of our primed and portable in-hospital ECMO system (April 2015). The primary end point was patient survival to discharge.
Results:
A total of 137 patients were placed on VA ECMO during the study period; n= 66 (48%) and n=71 (52%) before and after program initiation, respectively. The average age was 55 years old, with 69% being male. Non-ischemic cardiomyopathy was the etiology of heart failure in 55% of patients. There were no significant differences in demographics between the two groups. In the second era, the proportion of OR ECMO initiation decreased significantly (from 92% to 49%, P<0.01) as more patients received ECMO in other hospital units, including the emergency department for OHCA (P<0.01). Additionally, while the proportion of patients receiving central vs peripheral cannulation did not change, peripherally cannulated patients in the second era received smaller arterial cannulae (21 +/- 3.6 vs 17 +/- 3.1 French, P<0.01), and a greater proportion of these patients received distal limb perfusion cannulae (21% vs 45%, P=0.02). Survival to ECMO removal was similar for both groups (53% and 52%), while survival to hospital discharge was numerically higher for the current era (30% vs 42%, P=0.1). Finally, we observed a significant increase in clinical volume since initiation of the in-hospital, portable ECMO system from an average of 10 patients/year to 26 patients/year (P<0.01).
Conclusion:
After developing an in-hospital, primed and portable VA ECMO system, we observed increased clinical volume with more ECMO being initiated in non-OR settings. We conclude that more rapid deployment of VA ECMO may extend the treatment eligibility to more patients and improve patient outcomes.