Percutaneous Ventricular Assist Device vs Extracorporeal Membrane Oxygenation for Cardiogenic Shock: Insights from the National Readmission Database

Background:
Percutaneous ventricular assist devices (pVAD) and extracorporeal membrane oxygenation (ECMO) are increasing used for cardiogenic shock (CS) in hospitals throughout the United States. We aim to compare patient characteristics and clinical outcomes between pVAD and ECMO in CS.

Methods:
Using the National Readmission Database from 2010 to 2015, we identified adult patients that underwent pVAD or ECMO placement for CS; we excluded patients that underwent both procedures during the same hospitalization.

Results:
We identified 12,040 admissions for CS treated with mechanical circulatory support; 67.7% (8,148) underwent pVAD and 32.3% (3,892) ECMO placement. Patients that underwent pVAD had a mean age of 63.1 years, 29.2% were female, and 59.5% presented as acute coronary syndrome (ACS). Patients that underwent ECMO were younger (53.7 years), 31.2% were female and 23% presented with ACS. In-hospital mortality was significantly lower for pVAD when compared with ECMO (51.1% vs 58.7%, OR: 0.47, p<0.001). Patients that underwent pVAD had lower vascular complications (31.1% vs 66.0%, OR 0.29, p<0.001), cardiac complications (9.8% vs 20.1%, OR 0.45, p<0.001), acute kidney injury (57.0% vs 71.9%, OR 0.60, p<0.001), and stroke rates (4.1% vs 9.0%, OR 0.47, p<0.001). Length of stay and total hospital costs were lower for pVAD patients. Thirty-day readmission rates were higher for patients that underwent pVAD.

Conclusions:
The use of pVAD in cardiogenic shock was associated with lower in-hospital mortality, hospital complications, length of stay and hospital costs, but higher 30-day readmission when compared to ECMO.