Abstract
Abstract only Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used to support patients with cardiogenic shock. However, it is associated with an increase in systemic afterload which can lead to worsening cardiac function. The use of a percutaneous left ventricular assist device (pLVAD) plus ECMO has emerged as a strategy to offload the left ventricle, with some studies showing improved outcomes. Hypothesis: The use of ECMO plus pLVAD is associated with improved outcomes compared to the use of EMCO alone. Methods: The National Inpatient Sample was queried from 2011-2018 for relevant ICD-9 and ICD-10 codes to identify patients with cardiogenic shock supported with ECMO or ECMO plus a pLVAD (Ecpella) during the same admission. Baseline characteristics and in-hospital outcomes between groups were compared. Logistic regression was performed to adjust for pre-specified co-variates for outcomes. p-value was considered significant if <0.001. Results: Of 20,171 patients with cardiogenic shock supported with ECMO, 16,064 (79.6%) were treated with only ECMO and 4,107 (20.4%) were treated with ECMO plus pLVAD. Patients in the Ecpella group were more likely to be male (72% vs 66%), have a history of hypertension (50% vs 47%), diabetes (21% vs 15%), chronic kidney disease (27% vs 22%), coronary artery disease (54% vs 44%), myocardial infarction (6% vs 4%, p<0.001 for all). Age (55.6 vs 55.2 years (p = 0.09) and rate of atrial fibrillation and flutter were not significantly different. After adjusting for significant variables, patients in the Ecpella group, had higher rates of mortality (OR 1.2; CI [1.1-1.3]), stroke (OR 1.3; CI [1.2-1.5]), and major bleeding (OR 1.5; CI [1.4-1.7], p < 0.001 for all). The rate of inpatient dialysis was lower in the Ecpella group (OR 0.7; CI 0.7-0.8; p < 0.001). Conclusions: Cardiogenic shock patients treated with ECMO plus pLVAD had worse outcomes compared to patients treated with ECMO alone. Although it is possible that patients treated with ECMO plus pLVAD had a more critical presentation, further studies are needed to evaluate these findings.