Korean Circ J.  2023 Aug;53(8):535-547. 10.4070/kcj.2022.0348.

Comparison of Veno-arterial Extracorporeal Membrane Oxygenation Configurations for Patients Listed for Heart Transplantation

• Hong JA
• Kim AR
• Kim MJ
• Pack D
• Hyun J
• Lee SE
• Kim JJ
• Kang PJ
• Jung SH
• Kim MS

• KMID: 2545150
• DOI: http://doi.org/10.4070/kcj.2022.0348

Abstract

Background and Objectives
Veno-arterial extracorporeal membrane oxygenation (VAECMO) as a bridge to eventual heart transplantation (HT) is increasingly used worldwide. However, the effect of different VA-ECMO types on HT outcomes remains unclear.
Methods
This was a retrospective observational study of 111 patients receiving VA-ECMO and awaiting HT. We assessed 3 ECMO configuration groups: peripheral (n=76), central (n=12), and peripheral to central ECMO conversion (n=23). Cox proportional hazards regression and landmark analysis were conducted to analyze the effect of the ECMO configuration on HT and in-hospital mortality rates. We also evaluated adverse events during ECMO support.
Results
HT was performed in the peripheral (n=48, 63.2%), central (n=10, 83.3%), and conversion (n=11, 47.8%) ECMO groups (p=0.133) with a median interval of 10.5, 16, and 30 days, respectively (p<0.001). The cumulative incidence of HT was significantly lower in the conversion group (hazard ratio, 0.292, 95% confidence interval, 0.145–0.586, p=0.001). However, there was no difference in in-hospital mortality (log-rank p=0.433). In the landmark analysis, in-hospital mortality did not differ significantly among the 3 groups. Although we did note a trend toward lower HT in the conversion group, the difference was not statistically significant. Surgical site bleeding occurred mainly in the central, while limb ischemia occurred mainly in the peripheral groups.
Conclusions
We suggest that if patients are being stably supported with their initial ECMO configuration, whether it is central or peripheral, it should be maintained, and ECMO conversion should only be cautiously performed when necessary.

Keyword

Extracorporeal membrane oxygenation; Shock, cardiogenic; Cardiac transplantation

Figure

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  Figure 1 Impact of ECMO configuration and conversion on (A) heart transplantation and (B) in-hospital survival outcomes.ECMO = extracorporeal membrane oxygenation.

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  Figure 2 Landmark analysis for impact of ECMO configuration and conversion on (A) heart transplantation and (B) in-hospital survival outcomes.ECMO = extracorporeal membrane oxygenation.

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  Figure 3 Complications during ECMO support.VA-ECMO = Veno-arterial extracorporeal membrane oxygenation.

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  Figure 4 Subgroup analysis of long-term survival in patients who underwent heart transplantation using a Cox proportional hazard model.ECMO = extracorporeal membrane oxygenation.

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