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Improving Outcomes in INTERMACS 1 Category 1 Patients with Pre-LVAD, Awake Venous-Arterial Extracorporeal Membrane Oxygenation Support

Mori, Makoto*; McCloskey, Gerard; Geirsson, Arnar*; Mangi, Abeel A.*; Yun, James J.*; Jacoby, Daniel‡,§; Ahmad, Tariq‡,§; Bellumkonda, Lavanya‡,§; Lee, Forrester‡,§; Chen, Michael E.‡,§; Bonde, Pramod*,‡

doi: 10.1097/MAT.0000000000000908
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Effective strategies to optimize Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS 1) patients are in much need. A novel awake venous-arterial extracorporeal membrane oxygenation (aVA ECMO) allows for clinical assessments while temporarily supporting biventricular function and stabilizing end-organ functions. The aim of the study was to assess outcomes of patients with aVA ECMO support before durable left ventricular assist device (LVAD) implantation. We evaluated 83 patients who received durable LVAD in 2012–2015, of whom 19 received aVA ECMO support before durable LVAD. Kaplan–Meier and Cox proportional hazards analyses were conducted to assess post-LVAD survival. No complications were observed during the mean aVA ECMO support of 2.7 days. Unadjusted survival of aVA ECMO-supported patients and non-aVA ECMO INTERMACS 1 patients at 1 year were 84.2% and 66.7%, respectively (p = 0.15). Survival of aVA ECMO patients was comparable with that of non-aVA ECMO INTERMACS 2 cohort (84.2% vs. 80.8%) at 1 year. Multivariate analysis demonstrated a significant reduction in the risk of death in aVA ECMO group compared with INTERMACS 1 non-aVA ECMO group (hazard ratio [HR]: 0.17; p = 0.035). Awake venous-arterial (VA) ECMO allows bridge to next therapy and improves outcomes in INTERMACS category 1 patients with an effect comparable with downgrading the disease severity on the INTERMACS scale.

From the *Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut

Department of Anesthesia, Yale School of Medicine, New Haven, Connecticut

Section of Cardiac Surgery, Department of Surgery, Center for Advanced Heart Failure, Yale School of Medicine, New Haven, Connecticut

§Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.

Submitted for consideration January 2018; accepted for publication in revised form August 2018.

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

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 (www.asaiojournal.com).

Presented at the American Heart Association Scientific Sessions, Orange County, CA, November 2017.

Correspondence: Pramod Bonde, Section of Cardiac Surgery, Center for Advanced Heart Failure, Yale School of Medicine, BB204, 330 Cedar Street, New Haven, CT. Email: pramod.bonde@yale.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs