Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center.
OBJECTIVE
Advances in extracorporeal membrane oxygenation (ECMO) have enabled rapid deployment in a wide range of clinical settings. We report our experience with venoarterial (VA) ECMO in adult patients over 10 years and aim to identify predictors of mortality.


METHODS
This is a retrospective analysis of all adult patients undergoing VA ECMO at a tertiary care center from January 1, 2004, to December 31, 2013.


RESULTS
A total of 224 consecutive cases were reviewed. Eighty (35.7%) patients survived to discharge and 144 (64.3%) patients died. Patients requiring ECMO for heart transplant graft failure had lower mortality (51.6%) compared to all other etiologies (69.1%; P = .02). Forty-two percent (94 of the 224) of the patients required cardiopulmonary resuscitation (CPR) preceding ECMO and had higher rate of in-hospital mortality (74.5%) compared with patients without cardiac arrest (56.9%; P = .01). Patients with less than 30 minutes of CPR had a mortality rate of 40.0% compared to 91.4% for CPR > 30 minutes ( P = .001). In all, 24.1% of patients (54 of the 224) experienced ECMO-associated complications without significant increase in mortality, and 22.3% (50 of the 224) of the patients were transitioned to ventricular assist devices (VADs) or transplant. Patients bridged to a VAD including left ventricular assist devices and biventricular assist devices had a mortality rate of 56.1% versus 22.2% when bridged directly to transplant ( P = .01). Paradoxically, patients with an ejection fraction (EF) > 35% had a higher mortality compared to patients with an EF < 35% (75.3% vs 49.4%, respectively, P = .001).


CONCLUSIONS
Extracorporeal membrane oxygenation in patients with heart transplant graft failure had the best outcome. In patients who had cardiac arrest, prolonged CPR > 30 minutes was associated with very high mortality. Paradoxically, patients with EF > 35% had a higher mortality than patients with EF < 35%, likely reflecting patients with diastolic heart failure or noncardiac causes necessitating ECMO. For transplant candidates, direct bridge from ECMO to transplant could achieve a very good outcome.
1 Department of Cardiology, University of California, Los Angeles, CA, USA.
Bao G
BG
Tran
2 Department of Surgery, University of California, Los Angeles, CA, USA.
Kim
K
De La Cruz
2 Department of Surgery, University of California, Los Angeles, CA, USA.
Stuart
S
Grant
3 Department of Anesthesiology, University of California, Los Angeles, CA, USA.
Joseph
J
Meltzer
2 Department of Surgery, University of California, Los Angeles, CA, USA.
Peyman
P
Benharash
1 Department of Cardiology, University of California, Los Angeles, CA, USA.
Ravi
R
Dave
2 Department of Surgery, University of California, Los Angeles, CA, USA.
Abbas
A
Ardehali
2 Department of Surgery, University of California, Los Angeles, CA, USA.
Richard
R
Shemin
1 Department of Cardiology, University of California, Los Angeles, CA, USA.
Eugene
E
Depasquale
1 Department of Cardiology, University of California, Los Angeles, CA, USA.
Ali
A
Nsair
D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality* / Q000628:therapy; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
ECMO; cardiac arrest; cardiac surgery; critical care