MSS 2020 FALL ePOSTER
EVALUATING THE SAFETY AND EFFICACY OF BEDSIDE VENO-ARTERIAL (VA) ECMO DECANNULATION IN ICU
Zachary Bergman, Emily Bond, Rachel Heneghan, Scott Jackson, Nicholas Lemke, and Andrew Shaffer
University of Minnesota
Poster Presenter: Zachary Bergman, MD
University of Minnesota
Background: Initially designed for use in cardiac surgery, the application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has expanded in recent years to include use in refractory cardiogenic shock. As a result, the utilization of VA-ECMO has increased drastically over the last decade (Lorusso et al, 2019). Despite the apparent benefits of VA-ECMO use, there are numerous complications associated with this intervention and the risk of these complications increases with the time spent on VA-ECMO (Cheng et al, 2014). To date, no studies have evaluated the safety and efficacy of bedside VA decannulation in the ICU, however, bedside decannulations have been successfully performed without complication and may decrease amount of time on the ECMO circuit.
Objective: Evaluate the safety and efficacy of bedside VA-ECMO decannulation in the Intensive Care Unit (ICU) compared to decannulation in the operating room.
Methods: This study was a prospective and retrospective chart review performed at the M-Health Fairview University of Minnesota Medical Center. IRB approval was obtained prior to data abstraction. Decannulation was performed by the Cardiothoracic Surgeons either in the operating room or at the bedside in the ICU at their preference. The primary interventional cardiology ICU team requested timing of decannulation based on patient optimization Primary outcome studied was 90-day mortality. Secondary outcomes were total time on ECMO circuit, time to decannulation once deemed appropriate, operative time, and ECMO complications.
Results: Mortality between the two groups, ICU decannulation (n=18) versus OR decannulation (n=28), was not statistically significant (38.9% versus 21.4%, p=0.343), although there was a trend toward improved survival in the OR decannulation group. However, when evaluated individually, the ICU decannulation mortalities were attributed to underlying disease processes rather than procedurally related. There was a statistically significant decrease in time to decannulation in the ICU group by nearly 15 hours once deemed appropriate (median of 7.4 hours versus 22 hours, p=0.047). This resulted in a trend toward decreased total length of time on the ECMO circuit between the two groups (median 3.1 day in the ICU decannulation group versus 4.6 days in the OR decannulation group, p=0.108). There was also a trend toward decreased operative time with a median difference of 13 minutes in the ICU decannulation group (75.5 minutes versus 88 minutes, p=0.063).
Conclusion: The implementation of bedside VA-ECMO decannulation appears to be both safe and effective. Patients had decreased time on the ECMO circuit if decannulated in the ICU once deemed suitable, decreasing the overall time on ECMO by over 24 hours. Our data also shows a significantly shorter, more prompt operative intervention when performed in the ICU. Despite a trend toward decreased survival in this group, when evaluating the cause of death of patients in this group, they were all likely unrelated to this procedure. Ongoing evaluation of this intervention is required and will likely demonstrate no difference in survival while decreasing time to decannulation.
- Author(s) Zachary Bergman, Emily Bond, Rachel Heneghan, Scott Jackson, Nicholas Lemke, and Andrew Shaffer
- Program University of Minnesota
- Category Critical Care | Clinical Science
- Presentation Type ePoster