Outcomes of emergency medical service transport on venoarterial extracorporeal life support in cardiogenic shock

Abstract

Introduction

Veno-arterial extracorporeal life support (V-A ECLS) can be utilized to transport cardiogenic shock patients from a regional to a tertiary center. Mobile extracorporeal membrane oxygenation (ECMO) may be life-saving for critically ill patients to bridge to transplant or a higher level of care.

Methods

This study is a retrospective review of adult patients placed on V-A ECMO for cardiogenic shock between 2018 and 2022. Indications and outcomes were compared between patients who were cannulated at referring hospitals and transported via ambulance and those who were placed on VA-ECLS at our institution.

Results

547 patients with V-A ECMO placed due to cardiogenic shock were included. 94 patients were transported from referring hospitals, while 453 were placed on V-A ECMO at our institution. All were safely transported. In-hospital mortality was significantly higher in transport patients (49.1% vs 59.5%, p = .042). Transport patients had significantly higher rates of acute kidney injury requiring dialysis (27.8% vs 39.4%, p-value = .035) and cerebrovascular accident (6.2% vs 12.8%, p-value = .026). Kaplan-Meier curves showed 6-month survival was significantly lower in transport group (48.5% vs 37.3%, p = .021). Multivariate analysis demonstrated ECMO indication of AMI (OR 1.43, p-value = .037), ECPR (OR 2.45, p-value <.001), and history of COPD (OR 1.55, p-value = .014) were predictors of mortality within 12 months. Notably ECMO transport was not a significant risk factor.

Conclusions

Patients transported on V-A ECMO had higher in-hospital mortality, as well as lower 1-year survival. Careful patient selection is required.