ECMO for drug-refractory electrical storm without a reversible trigger: a retrospective multicentric observational...

Area of Science:

• Cardiology
• Critical Care Medicine
• Electrophysiology

Background:

• Drug-refractory electrical storm (ES) is a critical medical emergency with limited treatment guidelines.
• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for circulatory support in severe conditions.

Purpose of the Study:

• To evaluate the efficacy and outcomes of VA-ECMO in patients with drug-refractory ES lacking a reversible trigger.
• To describe the indications, management, complications, and survival rates associated with VA-ECMO in this patient population.

Main Methods:

• Retrospective observational study across four Iberian centers.
• Inclusion of 34 patients with drug-refractory ES requiring VA-ECMO for cardiogenic shock.
• Analysis of patient demographics, underlying conditions, ES characteristics, VA-ECMO support, interventions, complications, and outcomes.

Main Results:

• The majority of patients (71%) were male, with a median age of 57 years.
• Common causes of ES included monomorphic ventricular tachycardia/ventricular fibrillation (59%).
• A significant proportion (79%) survived to hospital discharge, with a 20% rehospitalization rate and 6% ES recurrence.
• Older age and longer time to ECMO were associated with non-survival.

Conclusions:

• VA-ECMO serves as a successful bridge therapy for drug-refractory ES without a reversible trigger.
• Successful management necessitates prolonged hospitalization and close collaboration between ECMO, electrophysiology, and heart transplant teams.
• VA-ECMO offers a high success rate in managing this life-threatening condition.