• Alan Gass, Chandrasekar Palaniswamy, Wilbert S Aronow, Dhaval Kolte, Sahil Khera, Hasan Ahmad, Linda J Cuomo, Robert Timmermans, Martin Cohen, Gilbert H Tang, Masashi Kai, Steven L Lansman, Gregg M Lanier, Ramin Malekan, Julio A Panza, and David Spielvogel.
• Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, N.Y., USA.
• Cardiology. 2014 Jan 1;129(3):137-43.

ObjectivesPatients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'.MethodsWe studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator.ResultsV-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury.ConclusionsPeripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population.© 2014 S. Karger AG, Basel.

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