title: Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise.
abstract: OBJECTIVE
  Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'.
  
  
  METHODS
  We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator.
  
  
  RESULTS
  V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury.
  
  
  CONCLUSIONS
  Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population.
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, N.Y., USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Gass
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.forename: Hasan
authors.initials: H
authors.lastname: Ahmad
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Cuomo
authors.forename: Robert
authors.initials: R
authors.lastname: Timmermans
authors.forename: Martin
authors.initials: M
authors.lastname: Cohen
authors.forename: Gilbert H
authors.initials: GH
authors.lastname: Tang
authors.forename: Masashi
authors.initials: M
authors.lastname: Kai
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
authors.forename: Gregg M
authors.initials: GM
authors.lastname: Lanier
authors.forename: Ramin
authors.initials: R
authors.lastname: Malekan
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D009202:Cardiomyopathies / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D016027:Heart Transplantation / Q000379:methods; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States