ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Effective strategies to optimize Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS 1) patients are in much need. A novel awake venous-arterial extracorporeal membrane oxygenation (aVA ECMO) allows for clinical assessments while temporarily supporting biventricular function and stabilizing end-organ functions. The aim of the study was to assess outcomes of patients with aVA ECMO support before durable left ventricular assist device (LVAD) implantation. ⋯ Survival of aVA ECMO patients was comparable with that of non-aVA ECMO INTERMACS 2 cohort (84.2% vs. 80.8%) at 1 year. Multivariate analysis demonstrated a significant reduction in the risk of death in aVA ECMO group compared with INTERMACS 1 non-aVA ECMO group (hazard ratio [HR]: 0.17; p = 0.035). Awake venous-arterial (VA) ECMO allows bridge to next therapy and improves outcomes in INTERMACS category 1 patients with an effect comparable with downgrading the disease severity on the INTERMACS scale.
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Peripheral veno-arterial extra corporeal life support (V-A ECLS) is an effective tool in treating refractory cardiogenic shock (RCS). Despite additional use of intra-aortic balloon pump, insufficient left ventricular unloading is a likely complication. We present herein our experience combining V-A ECLS and Impella to treat symptomatic, critical patients. ⋯ Factors including diabetes, patients aged over 60 years, surgery using extracorporeal circulation, adrenalin infusion, acute myocardial infarction, and chronic HFrEF are associated with day-30 mortality. Chronic HFrEF was an independent risk factor for the day-30 mortality [hazard ratio = 5.28 (1.38-20.21), P = 0.015]. Impella and V-A ECLS combination is a promising association for critical patients presenting symptomatic insufficient LV unloading, for weaning V-A ECLS or testing the right ventricle before a switch to left ventricle assist device support.