Escalation From Intra-Aortic Balloon Pump to Extracorporeal Membrane Oxygenation may be Associated With Poor Outcomes...

Area of Science:

• Cardiology
• Critical Care Medicine
• Mechanical Circulatory Support

Background:

• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for refractory cardiogenic shock (CS).
• Intra-aortic balloon pump (IABP) use in CS is being de-emphasized, yet escalation to VA-ECMO (IABP-ECMO) remains frequent.
• The outcomes associated with the IABP-ECMO strategy require further investigation.

Purpose of the Study:

• To investigate the association between escalating from IABP to VA-ECMO and patient outcomes.
• To compare outcomes between patients receiving IABP before VA-ECMO and those receiving direct VA-ECMO.
• To identify potential risks associated with the IABP-ECMO approach.

Main Methods:

• Retrospective analysis of adult patients from the Chinese Extracorporeal Life Support (CSECLS) registry (January 2017–August 2022).
• Patients were categorized into IABP-ECMO group (received IABP before VA-ECMO) and direct ECMO group (did not receive IABP).
• Primary outcome was in-hospital mortality; secondary outcomes included on-support mortality and limb ischemia.

Main Results:

• Out of 4,607 patients, 655 (14.2%) were in the IABP-ECMO group.
• The IABP-ECMO group was older and more likely to have acute myocardial infarction but less likely to have cardiac arrest prior to ECMO.
• In-hospital mortality was higher in the IABP-ECMO group (57.1% vs. 51.4%, p=0.007), persisting after multivariable adjustment (aOR 1.34).
• IABP-ECMO was also associated with increased on-support mortality (aOR 1.50) and limb ischemia (aOR 2.20).

Conclusions:

• Escalation from IABP to VA-ECMO in adults with cardiogenic shock is associated with increased in-hospital mortality.
• The IABP-ECMO strategy may also lead to higher rates of on-support mortality and limb ischemia.
• These findings suggest caution when considering IABP as a bridge to VA-ECMO.