Introduction:
Venoarterial extracorporeal life support (VA-ECLS) imposes increased afterload on the left ventricle (LV), potentially provoking LV distension and impaired ventricular recovery. Prior studies have suggested a survival benefit with LV mechanical venting (MV), but multi-center data are lacking.
Methods:
We queried the ELSO registry for adults undergoing VA-ECLS and stratified them by the use of MV, including intra-aortic balloon pump and percutaneous ventricular assist device. We excluded patients with pulmonary embolism, heart transplant, congenital and valvular heart disease, aortic disease, and central cannulation. The primary outcome was in-hospital mortality. Secondary outcomes were on-support mortality and major adverse events, including bleeding, hemolysis, ischemic stroke, limb ischemia, and renal injury. We used multivariable logistic regression modeling to adjust for relevant clinical covariates.
Results:
Among 12734 patients undergoing VA-ECLS, 3353 (26.3%) received MV devices. Patients with MV were older (mean age 56.3 vs 52.7 years), more often male (76.3% vs 68.5%), and more often supported for acute myocardial infarction (43.0% vs 21.7%), p<0.001 for all. Prior to ECLS, patients with MV had lower rates of cardiac arrest (51.7% vs 55.1%) but more commonly needed >2 vasopressors (41.8% vs 27.2%) and had a higher incidence of acute renal (17.1% vs 10.5%), liver (4.4% vs 3.1%), and respiratory failure (20.9% vs 15.9%), p<0.001 for all. Crude on-support (41.6% vs 47.8%, p<0.001) and in-hospital (56.7% vs 59.2%, p=0.01) mortality were lower in the MV group. In multivariable modeling, MV was associated with a significantly lower odds of mortality but higher odds of adverse events including medical and cannula site bleeding, hemolysis, limb ischemia and renal injury (Figure).
Conclusions:
Among adults supported with peripheral VA-ECLS, LV MV was associated with lower mortality despite a higher rate of important adverse events.
Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation