Venoarterial Extracorporeal Membrane Oxygenation - The Experience Of A Lowvolume Center.

Introduction Venoarterial extracorporeal membrane oxygenation (VA- -ECMO) is defined as the use of a modified cardiopulmonary bypass circuit for temporary mechanical circulatory support, with multiple applications. Objectives We aim to report our experience as a low-volume ECMO center. Materials and Methods Single center, retrospective study of all patients on VA-ECMO between November 2006 and July 2019. The primary endpoints were survival to discharge and one-year survival. Results Venoarterial ECMO was performed in 97 patients (74 adults, 23 children), 60% were male, mean adult age of 49,1±14,9 years old and mean paediatric age of 3,6±5,5 years old. Fifty-six patients were on cardiogenic shock (58%) and ECMO indications were postcardiotomy shock (n=29), acute decompensated chronic heart failure (n=8), acute myocardial infarction/ complicated percutaneous intervention (n=7), acute myocarditis (n= 4), acute pulmonary thromboembolism (n=4), arrhythmic storm (n=1), complicated vascular surgery (n=1), tracheoesophageal fistula repair (n=1) and massive hemoptysis (n=1). The remaining 41 patients (42%) were on venoarterial ECMO intraoperatively during lung transplantation due to haemodynamic instability. Eleven cardiogenic patients who did not recover, fulfilled heart transplantation criteria, with 2 patients being directly bridged-to-transplant and 9 were bridged to a VAD (one was successfully weaned and two bridged to heart transplantation). Overall weaning rate was 64%. Mean ECMO support time was 3,3±3,8 days, mean ICU stay was 27,2±46 days and mean hospital length of stay was 47,3±64,6 days. Survival at discharge was 51% and survival at one-year was 47%. Conclusions Low-volume institutions can perform ECMO with good results in a diversity of pathologies. Decision-making algorithms tailored to the center's characteristics are essential for the outcomes.