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Hemodynamic Aspects of Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiac Support

A Worldwide Survey

Siriwardena, Maithri*; Dozois, Matthew*; Fan, Eddy†,‡; Billia, Filio*

doi: 10.1097/MAT.0000000000001024
Original Article: PDF Only

There is limited data available to guide management of patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). An international cross-sectional survey of medical directors/program coordinators from Extracorporeal Life Support Organization centers was conducted. A hierarchical clustering on principle components was used. A total of 243 (55%) centers responded and were divided into three clusters: Cluster 1 (n = 102) had few high volumes and low specialized heart failure (HF) involvement; Cluster 2 (n = 75) had few high volumes and moderate HF involvement; Cluster 3 (n = 66) contained the majority of centers with >50 annual cases and high HF involvement. The most divergent responses were observed between Clusters 1 and 3 wherein Cluster 1 centers were less likely to change management based on pulse pressure (77% vs. 100%; p < 0.001) and would rather avoid inotropes to “rest the heart” (28%). Cluster 3 centers were more likely to perform daily echocardiograms (50% vs. 24%, p < 0.001), which were less likely to be exclusively performed by cardiologist (36% vs. 58%, p < 0.046) and base weaning on echocardiographic findings, when compared to Cluster 1 (3.97/5 vs. 3.56, p < 0.001). Responses were variable in management reflecting the lack of evidence for hemodynamic care for those supported with VA-ECMO.

From the *Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, Toronto, Ontario, Canada

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Submitted for consideration October 2018; accepted for publication in revised form April 2019.

Disclosure: The authors have no conflicts of interest to report.

Dr. Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr. Billia is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Maithri Siriwardena and Matthew Dozois contributed equally to this work.

Correspondence: Filio Billia, MD, PhD, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, 200 Elizabeth St., PMB 11–135, Toronto, Ontario, M5G 2N2. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs