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. 2023 Dec 21:17:152-161.
doi: 10.1016/j.xjon.2023.12.005. eCollection 2024 Feb.

Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock

Shan P Modi  1 , Yeahwa Hong  2 , McKenzie M Sicke  3 , Nicholas R Hess  4 , Wyatt J Klass  5 , Luke A Ziegler  5 , Ryan M Rivosecchi  6 , Gavin W Hickey  7 , David J Kaczorowski  4 , Raj Ramanan  1
Affiliations

Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock

Shan P Modi et al. JTCVS Open. .

Abstract

Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with concomitant percutaneous microaxial left ventricular assist device support is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with this support strategy have not been well described.

Methods: This study was a retrospective, single-center analysis of patients with CS due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support from December 2020 to January 2023.

Results: A total of 44 patients were included (AMI-CS, n = 20, and ADHF-CS, n = 24). Patients with AMI-CS and ADHF-CS had similar survival at 90 days postdischarge (P = .267) with similar destinations after support (P = .220). Patients with AMI-CS initially supported with VA-ECMO were less likely to survive 90 days postdischarge (P = .038) when compared with other cohorts. Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (P =.013; P = .030). Subanalysis of ADHF-CS patients into acute-on-chronic decompensated HF and de novo HF demonstrated no difference in survival or destination.

Conclusions: VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS with this support strategy. AMI-CS patients with initial VA-ECMO support have increased mortality in comparison to other cohorts. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with this support strategy.

Keywords: ADHF-CS; AMI-CS; VA-ECMO; cardiogenic; pVAD; shock.

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Conflict of interest statement

Dr Kaczorowski has received consultant and speaking fees from Medtronic and Abiomed and has an intellectual property interest in ECMOTek LLC. Dr Hickey has received speaking fees from Abiomed. Mr Klass receives consultant fees from Boston Scientific. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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No survival differences exist between CS etiologies supported with VA-ECMO and pVAD.
Figure 1
Figure 1
Cardiogenic shock (CS) etiology does not affect 90-day survival. A total of 62.5% (n = 16) of patients with acute decompensated heart failure (ADHF) CS survived after 90 days after venoarterial extracorporeal membrane oxygenation with concomitant percutaneous microaxial left ventricular assist device support compared with 45% (n = 9) of patients with acute myocardial infarction complicated by CS (P = .449). In a subanalysis of ADHF-CS, 41.7% (n = 5) of patients with ADHF-CS survived after 90 days postsupport compared with 83.3% (n = 10) of patients with de novo heart failure (P = .058). VA-ECMO, Venoarterial extracorporeal membrane oxygenation; pVAD, percutaneous microaxial left ventricular assist device; AMI, acute myocardial infarction.
Figure 2
Figure 2
Destination does not vary with cardiogenic shock (CS) etiology. Despite a higher proportion of patients with acute myocardial infarction (AMI) CS who died while on venoarterial extracorporeal membrane oxygenation with concomitant percutaneous microaxial left ventricular assist device support (55%; n = 11) compared with patients with acute decompensated heart failure (ADHF) complicated by CS (29%; n = 7), there was no statistical significance in destination between the 2 cohorts (P = .220). LVAD, Left ventricular assist device.
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