Characteristics and outcomes of combination VA-ECMO for cardiogenic shock

Abstract Background Use of VA-ECMO for cardiogenic shock is growing exponentially. The impact of VA-ECMO on in-hospital mortality among patients with CS due to heart failure or acute myocardial infarction remains poorly understood. Furthermore, the combination of VA-ECMO with IABP or Impella is also growing despite limited data supporting this approach. We sought to quantify in-hospital mortality among patients with CS due to HF or AMI in the presence or absence of concomitant IABP or Impella use. Methods We utilized the Cardiogenic Shock Working Group multi-center registry and focused on data obtained between 2021 and 2022. Patients managed with VA-ECMO alone, VA-ECMO and IABP or VA-ECMO and any left-sided transvalvular pump (Impella) were included in the analysis. Patients receiving IABP or Impella without VA-ECMO were excluded. Results Of the 1,634 CS subjects included in the analysis, 240 patients received VA-ECMO. 61.7% (n=148) were male. Mean age was 54.4±14.5. Baseline SCAI stage on admission for CS was Stage D (41.1%, n=76) and Stage E (46.0%, n=85). Among these patients, 5% (81), 4.5% (73), 5.9% (97) subjects received either VA-ECMO alone, VA-ECMO+IABP, or VA-ECMO+Impella respectively. In-hospital mortality among these groups for all cause CS, HF-CS, and MI-CS are shown in Figure 1A. In-hospital mortality among HF-CS stratified by acute on chronic HF (ACHF) or de novo HF are shown in Figure 1B. In-hospital mortality among HF-CS stratified by STEMI or Non-STEMI are shown in Figure 1C. Conclusions In-hospital mortality among VA-ECMO recipients for CS remains high and distinct among HF-CS and AMI-CS populations. Further research is needed in order to better understand the impact and trajectory of combined use of IABP or Impella with VA-ECMO among HF-CS and AMI-CS population.