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The following is a summary of “Peripheral-to-central extracorporeal corporeal membrane oxygenation switch in refractory cardiogenic shock patients: outcomes and bridging strategies,” published in the October 2024 issue of Critical Care by Besnard et al. 

Peripheral veno-arterial extracorporeal membrane oxygenation (pECMO) was the primary choice for refractory cardiogenic shock (rCS). Still, complications could delay bridging strategies, leading to a potential switch to peripheral-to-central ECMO (cECMO).    

Researchers conducted a retrospective study to assess in-hospital survival and bridging strategies in patients who underwent a peripheral-to-cECMO switch.   

They analyzed patients admitted to an ECMO-dedicated ICU from February 2006 to January 2023. Patients with rCS requiring pECMO who were switched to cECMO were included, and individuals with cECMO with initial mechanical circulatory support were excluded.   

The results showed that 80 patients were included, with a median [IQR25-75] age of 44 [29–53] years and a female-to-male ratio of 0.6. Refractory pulmonary edema was the main reason for switching; 30 patients (38%) were successfully bridged to heart transplantation (n = 16/80, 20%), recovery ((n = 10/80, 12%), or ventricle assist device (VAD) (n = 4/30, 5%), while the others died on cECMO ((n = 50/80, 62%). The most periodic complications were the need for renal replacement therapy (76%), hemothorax or tamponade (48%), the need for surgical revision (34%), mediastinitis (28%), and stroke (28%). The in-hospital and 1-year survival rates were 31% and 27% respectively. Myocardial infarction was the cause of rCS and independently linked with in-hospital mortality (HR 2.5 [1.3–4.9], P = 0.009).   

Investigators concluded switching from a failing pECMO to cECMO as a bridge-to-decision was a feasible strategy for patients with potential heart function recovery or transplantation. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01382-3#Abs1