The use of VA-ECMO, our experiences at Semmelweis University’s Heart and Vascular Center
Kulyassa Péter, Németh Balázs Tamás, Hartyánszky István, Szilveszter Bálint, Fazekas Levente, Pólos Miklós, Németh Endre1, Becker Dávid, Merkely Béla, Édes István Ferenc
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika,
1Aneszteziológiai és Intenzív Terápiás Klinika, Városmajori Részleg, Budapest
Mechanical circulatory support (MCS) was introduced in the 1960s, of which there is short-, mid- and long-term forms. This brief review discusses our experiences with the primary modality used in Hungary, the veno-arterial extracorporeal membrane oxygenator (VA-ECMO). We introduced the device with the most relevant information and summarized our clinic’s registry with patient characteristics and results in whom we applied this modality next to data of international studies. We collected data retro- and prospectively from 2012 to 2020 from patients treated with the VA-ECMO at our clinic. The primary endpoint we used was all cause mortality in this patient population of critical condition. Every indication, potential peripheral-central conversion and primary operation technique was involved in the analysis. We found that age above 65 and initial pH under 7.2 significantly affects mortality data. Acute coronary syndrome (ACS) as primary indication showed to be nearly significant, and acute rejection after hTX was a beneficial clinical scenario regarding survival. In international literature diabetes mellitus, elevated levels of lactate, kidney- and hepatic insufficiency were identified as contributing mortality predictors as well. Our results mostly coincide with the international mortality and risk factor data. Time is a very important factor for the survival of these patients. Therefore, it is very important to refer the patient’s refractory to non-MCS therapy to centers with VA-ECMO capability in time.