CARC14: Utilization and Outcomes of VAV-ECMO: A Systematic Review And Meta-Analysis

Background: We sought to understand the indications, utilization patterns, and outcomes of veno-arterial-venous extracorporeal membrane oxygenation (VAV-ECMO) by quantitatively pooling the existing evidence from the literature. Methods: Electronic search was performed to identify all relevant studies reporting VAV-ECMO usage. Five studies comprising 77 patients were selected and cohort-level data were extracted for further analysis. Results: Mean patient age was 60.9 (95% CI: 55.2, 66.5) years and 30% (23/77) were female. The majority of cases [91% (70/77)] were transitioned to VAV-ECMO from another pre-existing ECMO configuration: VA-ECMO in 55% (42/77) vs. VV-ECMO in 36% (28/77), p=0.04. Only 9% (7/77) of cases were directly placed on VAV-ECMO. Patients supported on VA-ECMO were transitioned to VAV-ECMO for differential hypoxia [59.5% (25/42)] and cardiopulmonary failure [40.5% (17/42)], while patients supported on VV-ECMO were transitioned to VAV-ECMO due to left ventricular failure [21.4% (6/28)], right ventricular failure [21.4% (6/28)], biventricular failure [14.3% (4/28)], or otherwise unspecified decrease in cardiac function [42.9% (12/28)]. Direct placement of VAV-ECMO was performed in 9% (7/77) for cardiopulmonary failure due to septic cardiomyopathy. The mean duration of hospital stay was 42.3 (95% CI: 10.5, 74.2) days, while ICU mortality was 46% (29, 64). Transition to durable LVAD was performed in 3% (2/64), while 3% (2/64) underwent heart transplantation. VAV-ECMO was successfully weaned to explantation in 33% (21/64) (Figure). Conclusion: VAV-ECMO is a viable option for optimizing cardiopulmonary support in selected patients. Survival to weaning or bridging therapy appears comparable to more common ECMO configurations. Figure 1. Indications and outcomes of VAV-ECMO