Initiation of Extracorporeal Membrane Oxygenation in the Cardiac Catheterization Laboratory: The Mayo Clinic Experience

Introduction. Extracorporeal membrane oxygenation (ECMO) support is indicated for the management of patients with cardiogenic shock or refractory cardiac arrest in the cardiac catheterization laboratory. The aim of this study was to review the outcomes of patients initiated on ECMO support in the cardiac catheterization laboratory. Methods. We performed a retrospective analysis of adult patients (>18 years old) initiated on ECMO support in the cardiac catheterization laboratory from 2010-2017. Baseline demographics, clinical characteristics, procedural details, and indication for ECMO support were reviewed. The outcomes assessed included 30-day mortality, blood product transfusion, vascular injury, prolonged respiratory failure, stroke, ischemic bowel, renal failure requiring hemodialysis, and compartment syndrome. Results. Between January 1, 2010 and December 31, 2017, a total of 25 patients were cannulated for ECMO in the cardiac catheterization laboratory. The mean age was 61 years and 56% of patients were men. Cardiac arrest was the most frequent indication for ECMO support (64%), followed by cardiogenic shock (28%). The 30-day mortality rate was 40%. The most frequent complications associated with ECMO were the need for vascular surgery (52%) and renal failure requiring hemodialysis (36%). The univariate predictors of 30-day mortality were age [P=.02; unit odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.15), history of tobacco use [P=.04; OR, 6; 95% CI,1.01-35.91), and Apache IV score [P =.02; unit OR, 1.02; 95% CI, 1.01-1.09). Conclusions. ECMO should be considered early during the resuscitation attempts of selected patients with ongoing cardiopulmonary resuscitation or refractory cardiogenic shock in the cardiac catheterization laboratory.