VA-ECMO vs VA ECMO plus IABP in Non-MI Cardiogenic shock: Outcomes analysing the Nationwide inpatient sample 2015-2018
Presenter
Krishna Prasad Kurpad, MBBS, Carle Illinois College of Medicine, Champaign, IL
Krishna Prasad Kurpad, MBBS, Carle Illinois College of Medicine, Champaign, IL, Harsh Mehta, M.D, Saint Barnabas Medical Center, West orange, NJ, Nadish Garg, M.D, Saint Barnabas Medical Center, West Orange, NJ, Sumit Sohal, M.D, Rutgers Newark Beth Israel Medical Center, Newark, NJ, Gautam Karteek Visveswaran, MBBS, FSCAI, Newark Beth Israel Medical Center, Cranford, NJ and Marc Cohen, M.D., Newark Beth Israel Medical Center, Newark, NJ
Keywords: Cardiogenic shock, Heart Failure and Hemodynamic support
Background:
Veno-arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) is often combined with Intra-aortic balloon pump (IABP) or Impella to optimally reduce left ventricular filling pressures when used in the setting of refractory Non-MI cardiogenic shock (NMICS). Our aim was to assess in-hospital outcomes of VA-ECMO compared to VA-ECMO plus IABP in patients with NMICS.
Methods:
NIS-HCUP database from years 2015 to 2018 was queried to identify patients admitted with NMICS. VA-ECMO alone compared to VA-ECMO plus IABP were identified. Baseline demographics, in-hospital outcomes and complications were compared. Statistical significance was assigned at p<0.05.
Results:
Out of 144700 NMICS admissions, VA-ECMO was utilized in 2825 patients.1896(67.1%) patients received VA-ECMO alone while 929 (32.9%) patients received both VA-ECMO and IABP. Baseline characteristics are shown in table below. Incidence of total major bleeding (7.51 vs 6.47, p-value: 0.001), sudden cardiac arrest (9.86 vs 8.63 p-value: 0.001) was higher in VA-ECMO alone group. Incidence of acute respiratory failure (61.87% vs 68.54% p-value: 0.001) and intubation (23.02% vs 27.93% p-value: 0.0051) and in-hospital mortality (35.97 vs 36.85 p-value: 0.001) was lower in VA-ECMO plus IABP group.
Conclusions
VA-ECMO plus IABP was associated with lower rates of acute respiratory failure, need for intubation and in-hospital mortality with an increased incidence of ventricular arrythmias and increased length of stay. Despite need for additional arterial access there was no increased bleeding reported with the use of IABP unloading.
