OPTIMISING VENOARTERIAL ECMO CARE: INSIGHTS FROM A CARDIAC CENTRE WITHOUT ON-SITE CARDIOSURGICAL EXPERTISE.

Introduction: This study evaluates the safety and efficacy of VA-ECMO in a cardiology center without on-site cardiac surgery, focusing on clinical outcomes, procedural details, and challenges.

Methods: A retrospective analysis was conducted on VA-ECMO cases between 2020 and 2023, examining indications, procedures, and outcomes.

The composite 7-day and 90-day survival rates were found to be 68.2% and 45.5%, respectively. Successful transport to a cardiac surgery center for orthotopic heart transplantation (OHT) was achieved in 3 patients, underscoring the potential of VA-ECMO as a bridge to definitive therapy. One patient underwent left ventricular assist device (LVAD) implantation as a destination therapy, highlighting the role of VA-ECMO in facilitating decision-making for long-term MCS options.

VA-ECMO was used in 44 patients, primarily for acute coronary syndrome (ACS) with cardiogenic shock (70%).(Fig. 1) 7-day and 90-day survival rates were 68.2% and 45.5%, respectively. 3 patients underwent OHT, 1 received LVAD. 41% needed IABP, 50% required ECMO during CPR (lower survival in prolonged no-flow >60 min). 17 cases had ECMO cannula complications (44% hematoma, 39% distal ischemia). 

Conclusion: This study provides insights into VA-ECMO use without on-site cardiac surgery. Understanding its challenges and successes is crucial for optimizing patient care in similar settings. The results inform future discussions on VA-ECMO's role in centers without cardiosurgical support.