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Initiation of Extracorporeal Membrane Oxygenation in the Cardiac Catheterization Laboratory: The Mayo Clinic
Bradley Ternus1, Jacob Jentzer, Kyle Bohman
1UW Health University Hospital, 600 Highland Avenue, Madison, WI 53792. bwternus@medicine.wisc.edu.
Insights
Extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization lab is for cardiogenic shock or cardiac arrest. This study found a 40% 30-day mortality, with age and Apache IV score predicting survival.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Cardiovascular Surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) is a critical intervention for patients with severe cardiogenic shock or refractory cardiac arrest.
- Its application within the cardiac catheterization laboratory setting presents unique logistical and clinical considerations.
Purpose of the Study:
- To review the outcomes of patients initiated on ECMO support within the cardiac catheterization laboratory.
- To identify complications and predictors of mortality in this specific patient population.
Main Methods:
- Retrospective analysis of adult patients (>18 years) who received ECMO in the cardiac catheterization laboratory between 2010 and 2017.
- Review of baseline demographics, clinical characteristics, procedural details, ECMO indications, and post-procedure outcomes.
- Assessment of complications including mortality, vascular injury, and organ failure.
Main Results:
- Twenty-five patients were included, with cardiac arrest (64%) being the primary indication for ECMO.
- The 30-day mortality rate was 40%.
- Common complications included vascular surgery requirement (52%) and renal failure requiring hemodialysis (36%). Age, tobacco use history, and Apache IV score predicted 30-day mortality.
Conclusions:
- ECMO initiation in the cardiac catheterization laboratory is a viable option for selected patients with refractory cardiogenic shock or cardiac arrest.
- Early consideration of ECMO during resuscitation efforts in this setting may improve outcomes for critically ill patients.
Introduction:
Extracorporeal membrane oxygenation (ECMO) support is indicated for the management of patients with cardiogenic shock or refractory cardiac arrest in the cardiac catheterization laboratory. The aim of this study was to review the outcomes of patients initiated on ECMO support in the cardiac catheterization laboratory.
Methods:
We performed a retrospective analysis of adult patients (>18 years old) initiated on ECMO support in the cardiac catheterization laboratory from 2010-2017. Baseline demographics, clinical characteristics, procedural details, and indication for ECMO support were reviewed. The outcomes assessed included 30-day mortality, blood product transfusion, vascular injury, prolonged respiratory failure, stroke, ischemic bowel, renal failure requiring hemodialysis, and compartment syndrome.
Results:
Between January 1, 2010 and December 31, 2017, a total of 25 patients were cannulated for ECMO in the cardiac catheterization laboratory. The mean age was 61 years and 56% of patients were men. Cardiac arrest was the most frequent indication for ECMO support (64%), followed by cardiogenic shock (28%). The 30-day mortality rate was 40%. The most frequent complications associated with ECMO were the need for vascular surgery (52%) and renal failure requiring hemodialysis (36%). The univariate predictors of 30-day mortality were age (P=.02; unit odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.15), history of tobacco use (P=.04; OR, 6; 95% CI, 1.01-35.91), and Apache IV score (P=.02; unit OR, 1.02; 95% CI, 1.01-1.09).
Conclusions:
ECMO should be considered early during the resuscitation attempts of selected patients with ongoing cardiopulmonary resuscitation or refractory cardiogenic shock in the cardiac catheterization laboratory.
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