Table 3.
Characteristics of the main studies that evaluated venoarterial extracorporeal membrane oxygenation in patients with refractory cardiogenic shock and/or in-hospital cardiac arrest.
| Author | N | Design | Inclusion criteria | Exclusion criteria | Primary outcome | Main findings | Conclusion |
|---|---|---|---|---|---|---|---|
| Dangers et al.(5) | 105 | Retrospective analysis, single center | Patients who used VA-ECMO due to cardiogenic shock with dilated cardiomyopathy | Refractory cardiogenic shock due to complications of acute heart disease (myocardial infarction and myocarditis) Patients who used VV-ECMO |
Description of characteristics, outcomes and risk factors associated with worse outcomes in patients on VA-ECMO due to cardiogenic shock | One-year survival of 42% One-year survival of patients with pre-VA-ECMO SOFA < 7 was 52%. One-year survival of patients with pre-VA-ECMO SOFA > 13 of 17% 67% of patients used IABP in combination with VA-ECMO. |
VA-ECMO as a bridge to left ventricular assist device or heart transplantation should be considered in patients with cardiogenic shock VA-ECMO is best indicated in patients with SOFA < 11 |
| Rastan et al.(6) | 517 | Observational prospective study | Patients who used VA-ECMO for refractory cardiogenic shock after cardiotomy | Not specified | Identification of risk factors associated with hospital outcomes and long-term outcomes | Six-month survival of 17.6% One-year survival of 16.5% Five-year survival of 13.7% Age > 70 years, diabetes, renal failure prior to surgery, obesity, lactate > 4 mmol/L are risk factors for in-hospital mortality |
VA-ECMO is an acceptable option for patients with refractory cardiogenic shock after cardiotomy |
| Chen et al.(7) | 172 | Observational prospective study, single center. Matching performed with propensity score | Intrahospital cardiac arrest Age between 18 and 75 years Cardiac arrest lasting > 10 minutes |
Previous irreversible neurological disease Terminal stage cancer Uncontrolled bleeding of traumatic origin |
Survival to hospital discharge in the ECMO group of 28.8% (17/59) and 12.3% (14/113) in the control group (log-rank p < 0.0001) | Return to spontaneous circulation was higher in the ECMO group. One-year survival in the ECMO group was 18.6% (11/59) One-year survival in the control group was 9.7% (11/113). |
VA-ECMO in in-hospital cardiac arrest increased survival and improved neurological outcomes compared to conventional CPR |
| Combes et al.(8) | 81 | Retrospective study | Patients who used VA-ECMO for refractory cardiogenic shock | Patient using VV-ECMO | Identification of early and independent predictors of ECMO failure and description of the outcome of patients on ECMO support during ICU stay | Variables associated with increased mortality: onset of ECMO during cardiac arrest, severe hepatic or renal dysfunction and female sex ECMO due to fulminant myocarditis was associated with better outcomes |
VA-ECMO in patients with refractory cardiogenic shock is effective in rescue in 40% patients Survival in the ICU in the ECMO group was 42% (34/81). |
| Pagani et al.(9) | 33 | Not specified | Absence of contraindication to heart transplantation Age < 66 years Refractory cardiogenic shock Severe hemodynamic instability |
Need for VA-ECMO after transplant failure Elective and planned use of VA-ECMO for coronary angioplasty |
Evaluation of the use of ECMO as a bridge to LVAD and subsequent transplantation in selected high-risk patients | Small sample size VA-ECMO is effective in the initial stabilization of patients with refractory cardiogenic shock, but maintenance of VA-ECMO is associated with a high rate of complications The cost of VA-ECMO compared to the LVAD was lower but had a higher incidence of complications |
The initial stabilization of patients with refractory cardiogenic shock with VA-ECMO as a bridge to LVAD or heart transplantation is associated with better outcomes at 1 year. |
VA-ECMO - venoarterial extracorporeal membrane oxygenation; VV-ECMO - venovenous extracorporeal membrane oxygenation; SOFA - Sequential Organ Failure Assessment Score; IABP - intra-aortic balloon pump; LVAD - left ventricular assist device; CPR - cardiopulmonary resuscitation; ICU - intensive care unit.