Effect of Portable, In-Hospital Extracorporeal Membrane Oxygenation on Clinical Outcomes

Area of Science:

• Cardiology
• Critical Care Medicine
• Biomedical Engineering

Background:

• Delays in mechanical circulatory support initiation negatively impact survival in cardiogenic shock.
• Rapid initiation of venoarterial extracorporeal membrane oxygenation (VA ECMO) is crucial for patient outcomes.
• Existing transport protocols to the operating room (OR) for VA ECMO can be time-consuming and detrimental.

Purpose of the Study:

• To evaluate the impact of a primed and portable in-hospital VA ECMO system on patient survival and treatment initiation times.
• To compare outcomes between patients receiving VA ECMO before and after the implementation of a new system.
• To assess changes in patient cohort acuity and clinical volume.

Main Methods:

• Retrospective review of 137 patients undergoing VA ECMO.
• Comparison of two time periods: before and after the introduction of a primed, portable VA ECMO system.
• Analysis of primary endpoint: patient survival to discharge, and secondary endpoints including initiation location and patient condition at initiation.

Main Results:

• The implementation of a portable VA ECMO system significantly decreased the proportion of OR initiations (92% to 49%).
• More patients received VA ECMO in alternative locations like the emergency department and during cardiac arrest (12% to 38%).
• Patient survival to discharge remained equivalent (30% vs. 42%) despite a sicker patient cohort and increased clinical volume.

Conclusions:

• An in-hospital, primed, and portable VA ECMO program increases clinical volume and allows for more rapid deployment.
• This system enables treatment initiation in diverse locations, potentially extending eligibility to more critically ill patients.
• Faster VA ECMO deployment is associated with equivalent survival rates, even in a more compromised patient population.