Extracorporeal membrane oxygenation for acute decompensated heart failure: Encouraging long term outcomes

Cardiogenic shock (CS) secondary to acute decompensated heart failure (ADHF) is a life-threatening condition that may require the use of mechanical circulatory support (MCS). Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) represents one of the first-line temporary MCS options.

We conducted a single-center, retrospective observational cohort study of adult patients with CS secondary to ADHF that required VA ECMO at our institution from 2014 to 2023. Patients requiring extracorporeal cardiopulmonary resuscitation (ECPR) or initially placed on venovenous (VV) ECMO were excluded. Baseline characteristics, ECMO support details, and clinical outcomes were analyzed. The primary outcomes were survival to hospital discharge and at 2 years.

A total of 69 patients were included. The median age was 55 years old and 60.9% were male. All patients were cannulated peripherally, with a median duration of support of 10 days. ECMO weaning was achieved in 73.9% and 56.5% survived to hospital discharge. The 2-year survival rate was 46.3%. From the total number of patients, 36.2% were bridged to durable MCS, 16% were weaned and survived to discharge, and 13% underwent heart transplantation. The most common complications included renal replacement therapy (34.8%), bleeding (20.3%), and infection (16%). Notable complications that were associated with worse outcomes included neurologic events, bleeding complications, and renal replacement requirement.

In patients with ADHF-CS, VA ECMO is a viable short-term support strategy that facilitates bridging to recovery or advanced therapies.