EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT AS TREATMENT FOR CARDIOGENIC SHOCK: TREATMENT STRATEGIES AND ANALYSIS OF RISK FACTORS

Background and Aim: RotaFlow and CardioHelp (Getinge), used in central (c-) or peripheral (p-) veno-arterial (VA) extra-corporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for patients with cardiogenic shock (CS). Methods: Between 2005 and 2024, 359 consecutive adult patients were supported on VA ECMO, at our institution (239 men; age 55.1±14.2 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of post-cardiotomy (n=134) and primary donor graft failure (n=39); post-acute myocardial infarction CS (n=79); acute myocarditis (n=34); and acute decompensation on chronic heart failure (n=27). Results: A p-ECMO setting was established in 241(67.13%) patients while c-ECMO in 118 (32.9%). Overall mean support time was 5.1±4.8 days. 187(52,1%) patients died on ECMO. Overall success rate was 48%, in terms of survival on ECMO (n = 241), weaning from mechanical support (n=132;54.8%), bridge to ventricular assist device (n=13;5.47%), and heart transplantation (n=26;10.7%). Stepwise Cox regression multivariate identified age, blood lactate level and SAPS II score value as significant predictors of mortality on ECMO (P=0.040, hazard ratio [HR]=2.01; 95% confidence interval [CI]=1.00–3.03; P<0.0001, HR=3.63; 95% CI=1.03-5.12 and P=0.017, HR=2.4; 95% CI=1.00–3.04, respectively), while “awake-on- ECMO condition” was a significant predictor of survival (P=0.023, HR=0.48; 95% CI=0.26- 1.90). c-ECMO population had significantly higher rate of rethoracotomy for bleeding (50%). Significant differences at 30-days were seen by comparing Kaplan-Meier survival estimates of left ventricular (LV) venting vs. no-LV venting cohorts (p=0.0073). Conclusions: A proper weight of pre-operative patients’ characteristics and a proactive LV venting set may contribute to improve the outcomes on ECMO support.