Impact of a multidisciplinary ECMO-team on the prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock and cardiac arrest

Abstract

Objective. We aimed to analyze whether the creation of an Extracorporeal membrane oxygenation Team (ECMO T) has modified the prognosis of patients undergoing veno-arterial ECMO (VA-ECMO) for refractory cardiogenic shock (CS) or cardiac arrest (CA). Materials and methods. Observational, single-center, retrospective study that compared the outcomes of VA-ECMO implantation for refractory CS or CA in two consecutive periods: between 2014 and April 2019 (pre-ECMOTeam), and between May 2019 and December 2022 (post-ECMOTeam). The study assessed in-hospital and ECMO survival, complications, and annual ECMO volume as endpoints. Results. 83 patients were included (36 pre-ECMOT and 47 post-ECMOT). The mean age was 53 +/-13 years. The most common reason for device indication was different: post-cardiotomy shock (47.2%) pre ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal cardiopulmonary resuscitation was 14.5%. The median duration of VA-ECMO was longer after ECMO team implementation: 8 days (interquartile range [IQR]: 5-12.5) vs. five days (IQR: 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37), and the survival rate from VA-ECMO was 60.2% (55.6% pre-ECMO T vs. 63.8% post-ECMO T; p=0.50). The volume of VA-ECMO implantation was significantly higher in the post-ECMO team period (13.2 +/-3.5 per year vs. 6.5 +/-3.5 per year, p=0.02). The rate of complications was similar in both groups. Conclusions. After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients underwent VA-ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMOT, the most common reason for device indication was CS, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.