Complications of microaxial flow pump and VA-ECMO in infarct-related cardiogenic shock: Insights from the Netherlands heart registration

BACKGROUND: Active mechanical circulatory support (MCS) is associated with high complication rates. Reducing device-related complications may improve outcomes in patients with infarct-related cardiogenic shock (AMI-CS). This study aims to provide in-depth insight in the occurrence, specification and timing of complications in patients receiving active MCS, providing valuable starting points for clinical practice and future studies to reduce complications. METHODS: This real-world, multicentre study, using data from the Netherlands Heart Registration PCI-Registry, describes AMI-CS patients that underwent PCI and received MCS between 2017 and 2021 across 9 Dutch hospitals. RESULTS: This registry included 241 patients with a mean age of 59.7 years and predominantly male (78.0 %). Microaxial flow pump (MFP), VA-ECMO and MFP + VA-ECMO were used in 93 (38.6 %), 121 (50.2 %) and 27 (11.2 %) patients. MFP + VA-ECMO was associated with highest complication rates, particularly bleeding events (67 % vs. MFP: 33 % vs. VA-ECMO: 40 %). Differences in bleeding events persisted while accounting for competing risk of death (subdistribution hazard ratio (SHR) MFP + VA-ECMO vs. MFP: 2.33 1.33-4.07; SHR MFP + VA-ECMO vs. VA-ECMO: 2.00 1.19-3.36). SHR for VA-ECMO vs. MFP was 1.18 0.74-1.90). Bleeding events were observed within the first days of support, but also on the day of explant and thereafter. Access-site related bleeding events accounted for 51 % of all bleeding events. CONCLUSIONS: Combined use of MFP and VA-ECMO was associated with higher complication rates, particularly bleeding events, compared to single device use. Complication rates between MFP and VA-ECMO were not significantly different. Importantly, patients are still at risk for bleeding events during and after explant of MCS devices.