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Published on: June 12, 2021
Peripheral venoarterial extracorporeal membrane oxygenation for periprocedural Cardiogenic shock during
Fernando J Verdugo1, Pabla Cataldo1, Jorge Sandoval1
1Department of Cardiology, Instituto Nacional del Tórax, Santiago, Chile.
Insights
Peripheral venoarterial extracorporeal membrane oxygenation (pVA-ECMO) can be a life-saving intervention for cardiogenic shock during interventional cardiology procedures. This study shows high survival rates, suggesting pVA-ECMO is a valuable bridge to recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is an uncommon but serious complication during cardiac catheterization procedures.
- High-risk patients and complex interventions increase the likelihood of periprocedural CS.
Purpose of the Study:
- To evaluate the clinical outcomes of patients treated with peripheral venoarterial extracorporeal membrane oxygenation (pVA-ECMO) for CS.
- To assess the efficacy of pVA-ECMO as a bridge to recovery in interventional cardiology settings.
Main Methods:
- Retrospective review of seven patients who received pVA-ECMO for CS between January 2014 and October 2018.
- Analysis of patient demographics, procedural details, ECMO parameters, and clinical outcomes.
Main Results:
- pVA-ECMO was initiated within 6 hours of the interventional cardiology procedure in all patients.
- All patients had coronary artery disease; PCI complications occurred in five patients.
- Survival rates were high at 85.7% at hospital discharge and 12-month follow-up, with minimal vascular access complications.
Conclusions:
- Peripheral venoarterial extracorporeal membrane oxygenation (pVA-ECMO) is a viable option for managing periprocedural cardiogenic shock.
- The use of pVA-ECMO in this series was associated with favorable clinical outcomes and high survival rates, serving as an effective bridge to recovery.
Background:
Cardiogenic shock (CS) is uncommon in the cardiac catheterization laboratory (CCL) among patients undergoing coronary angiography. Periprocedural CS is more frequent in high-risk patients and in technically demanding procedures.
Aim:
To describe the clinical outcomes of patients who underwent peripheral venoarterial extracorporeal membrane oxygenation (pVA-ECMO) for CS associated with interventional cardiology procedures.
Material And Methods:
Review of clinical records of seven patients treated between January 2014 and October 2018.
Results:
pVA-ECMO was implanted within 6 hours of the interventional cardiology procedure. All patients had coronary artery disease and one of them also had symptomatic severe aortic stenosis. One patient entered the CCL in cardiac arrest. Percutaneous coronary intervention (PCI) was performed in all patients; four patients underwent an emergency procedure and five patients experienced PCI complications. One patient undergoing transcatheter aortic valve replacement suffered acute severe aortic regurgitation. An intra-aortic balloon pump was inserted at the CCL in five patients. Six patients experienced cardiac arrest. Mean SAVE score was -4.3 and baseline lactate 55 mg/dl. pVA-ECMO mean duration was 5 ± 4 days. Survival after both hospital discharge and 12 months of follow-up was 85.7% Regarding vascular access complications, we observed one access site hematoma and one episode of cannulation site bleeding requiring surgical repair.
Conclusions:
pVA-ECMO should be considered in patients with periprocedural CS as a bridge to recovery. Its use was associated with improved clinical outcomes in this series.
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