Clinical Outcomes of VA-ECMO in acute and critical cardiac illnesses: A Single-Center Experience

Introduction: Acute and critical cardiac illnesses have attracted considerable attention because of their high mortality rates. Various innovative treatment methods including extracorporeal life support have been used to save the lives of patients with critical cardiac illnesses. This study aimed to evaluate the clinical efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in treating critical cardiac illnesses. Methods: We retrospectively analyzed data from an observational study conducted in China. The study population included adult patients with acute and critical cardiac illnesses admitted to the intensive care unit between January 1, 2021, and December 31, 2023. The primary endpoints were the successful reversal of cardiogenic shock and other related outcomes. Results: A total of 57 patients with acute and critical cardiac illnesses underwent VA-ECMO for refractory cardiogenic shock. These patients included 31 with acute coronary syndrome, 14 with fulminant myocarditis, 4 with stress-induced cardiomyopathy, and 8 with sepsis-induced myocardial depression. The median duration of VA-ECMO support was 120 h. Among the 31 patients with acute coronary syndrome, 17 (54.8%) had successfully reversed cardiogenic shock. In the group of 14 patients with fulminant myocarditis, cardiogenic shock was successfully reversed in 7 patients (50%). All four patients with stress-induced cardiomyopathy achieved successful reversal of cardiogenic shock (100%). Among the eight patients with sepsis-induced myocardial depression, five (62.5%) showed successful recovery of cardiac function. The overall cardiogenic shock reversal, 30-day survival, and 1-year overall survival rates were 54.4% (31/57), 45.6% (26/57), and 43.9% (25/57), respectively. Multivariate logistic regression analysis demonstrated that requiring additional continuous renal replacement therapy following VA-ECMO initiation was independently associated with in-hospital mortality. Conclusions: For refractory cardiogenic shock caused by acute and critical cardiac illnesses, VA-ECMO can effectively improve cardiac function, but it does not significantly increase the survival rate.