Emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported percutaneous interventions in refractory cardiac arrest and profound cardiogenic shock. (March 2021)

• Record Type: Journal Article
• Authors: Radsel, Peter; Goslar, Tomaz; Bunc, Matjaz; Ksela, Jus; Gorjup, Vojka; Noc, Marko
• Is Part Of: Resuscitation. Volume 160(2021)
• Page Start: 150
• Page End: 157
• Publication Date: 2021-03
• Subjects: BARC Bleeding Academic Research Consortium -- CA cardiac arrest -- CABG coronary artery bypass grafting -- CPC Cerebral performance category -- CS cardiogenic shock -- E-CPR cardiopulmonary resuscitation with arterio-venous extracorporeal membrane oxygenation -- EP invasive electrophysiology -- IABP intra-aortic balloon counterpulsation -- LVAD left ventricular assist device -- PCI percutaneous coronary intervention -- TAH total artificial heart -- TAVI transcatheter aortic valve implantation -- VA ECMO veno-arterial extracorporeal membrane oxygenation -- VSD ventricular septal defect -- VT ventricular tachycardia; Cardiogenic shock -- Cardiac arrest -- VA ECMO -- PCI -- TAVI; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2020.11.028
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aims: We investigated the spectrum of emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported interventions including percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI) and invasive electrophysiology (EP). Methods and results: Between June 2010 and February 2020, 52 consecutive patients underwent VA ECMO implantation for refractory cardiac arrest (E-CPR) and 78 for profound cardiogenic shock. Percutaneous interventions on VA ECMO included PCI (n = 29), TAVI (n = 4) and EP (n = 1). Surgical interventions were cardiac (n = 36) or non-cardiac (n = 5). During PCI, ECMO flow was maintained at 2.7 ± 1.0 L/min. Of the 40 treated lesions, 48% were located on left anterior descending and 20% on the left main artery. An average 2.0 ± 1.8 DES/patient with diameter 3.2 ± 0.5 mm and stented length 41 ± 35 mm were implanted. PCI success was 83%. TAVI was performed in 4 patients with left ventricular ejection fraction 21 ± 10% and mean aortic valve gradient 41 ± 5 mmHg. After successful valve implantation supported by 1.4 ± 0.1 L/min ECMO flow, mean gradient decreased to 11 ± 5 mmHg without significant aortic regurgitation. In one patient radiofrequency ablation of His bundle followed by permanent pacemaker implantation was performed under ECMO flow of 2.8 L/min. Overall survival to hospital discharge with good neurological recovery was 29% in E-CPR and 44% in profound cardiogenic shock. Conclusions: Our study showed feasibility and effectiveness of VA ECMO-supported percutaneous interventions in patients with profound hemodynamic collapse.