(229) Retrieval to Recovery: VA ECMO Gives Patients a Chance

Introduction: ECMO rescue is extremely labor and resource intensive. Our study evaluated the quality and efficacy of ECMO retrieval in patients requiring V-A ECMO in comparison to those placed on V-A ECMO at our institution.

Methods: A retrospective chart review of all patients requiring V-A ECMO from 10/2014 to 12/31/2022 was performed.

Results: Since program inception, 557 patients were placed on V-A ECMO. After exclusion of those placed on ECMO during active CPR (120 patients), 437 patients were included. There were 172 V-A ECMO patients cannulated at outside hospitals and 265 patients that were placed on support at our hospital.
Our team travelled to 57 hospitals among 4 states. We travelled a median of 20 miles (0.5-350) for retrievals. No major complications or adverse events were noted in route to our hospital.
Our intensivists cannulated more than 80% of patients in both the retrieved and on-site groups. The groups had similar age, gender, body mass index, creatinine, bilirubin, platelet counts, vasopressor requirements, pre-ECMO hospital length of stay and pre-ECMO need for renal replacement therapy (RRT). Patients that were retrieved had higher SOFA scores (13.4 ±2.8 vs 12.4 ±3.1, p< 0.01) and lactic acid levels (7.1 ±5 vs 5.9 ±4.6, p< 0.01). More patients in the rescue group had other type of mechanical circulatory support prior to ECMO initiation (49% vs 36%, p=0.01). Most common indications for V-A ECMO included post cardiotomy cardiogenic shock followed by acute myocardial infarction.
Patients that were retrieved had lower survival to discharge as compared to patients cannulated at our hospital (42.2% vs 55.8%, p=0.01).
More patients in the retrieved group had leg ischemia (14% vs 7%, p=0.02), required circuit changes (16% vs 4.5%, p< 0.01), and RRT (34% vs 24%, p=0.02). There were no significant differences in complication rates in bleeding, neurologic events, cannula site infections or patients requiring left ventricular unloading.

Conclusions: ECMO retrieval offers a lifesaving intervention for critically ill patients. Interestingly, retrieved patients had a higher mortality in our study. By improving the efficiency of the retrieval process such as encouraging earlier referrals, patients may be placed on ECMO sooner, likely improving mortality and clinical outcomes.