Objectives: Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the ‘bridge to recovery'. Methods: We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator. Results: V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury. Conclusions: Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from ‘bridge to recovery' to heart transplantation for the management of this critically ill population.

Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators: Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287-1296.
Awad HH, Anderson FA Jr, Gore JM, Goodman SG, Goldberg RJ: Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Am Heart J 2012;163:963-971.
Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, Ackermann H, Zwissler B, Kleine P, Moritz A: Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg 2008;135:382-388.
Tang GH, Malekan R, Kai M, Lansman SL, Spielvogel D: Peripheral venoarterial extracorporeal membrane oxygenation improves survival in myocardial infarction with cardiogenic shock. J Thorac Cardiovasc Surg 2013;145:e32-e33.
Doll N, Kiaii B, Borger M, Bucerius J, Krämer K, Schmitt DV, Walther T, Mohr FW: Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 2004;77:151-157.
Slottosch I, Liakopoulos O, Kuhn E, Deppe AC, Scherner M, Madershahian N, Choi YH, Wahlers T: Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: a single-center experience. J Surg Res 2013;181:e47-e55.
Lin CH, Chang JS, Li PC: The rescue of acute fulminant myocarditis by extracorporeal membrane oxygenation in pediatric patients. Acta Paediatr Taiwan 2005;46:201-205.
Ankersmit HJ, Ullrich R, Moser B, Hoetzenecker K, Hacker S, German P, Krenn C, Horvat R, Grimm M, Wolner E, Zuckermann A: Recovery from giant cell myocarditis with ECMO support and utilisation of polyclonal antithymocyte globulin: a case report. J Thorac Cardiovasc Surg 2006;54:278-280.
Cohen MI, Gaynor JW, Ramesh V, Karl TR, Steven JM, Posner J, Clark BJ 3rd, Rhodes LA: Extracorporeal membrane oxygenation for patients with refractory ventricular arrhythmias. J Thorac Cardiovasc Surg 1999;118:961-963.
Tsai FC, Wang YC, Huang YK, Tseng CN, Wu MY, Chang YS, Chu JJ, Lin PJ: Extracorporeal life support to terminate refractory ventricular tachycardia. Crit Care Med 2007;35:1673-1676.
Malekan R, Saunders PC, Yu CJ, Brown KA, Gass AL, Spielvogel D, Lansman SL: Peripheral extracorporeal membrane oxygenation: comprehensive therapy for high-risk massive pulmonary embolism. Ann Thorac Surg 2012;94:104-108.
Kai M, Tang GH, Malekan R, Lansman SL, Spielvogel D: Venoarterial extracorporeal membrane oxygenation for right heart failure complicating left ventricular assist device use. J Thorac Cardiovasc Surg 2013;147:e31-e33.
Chou NK, Chi NH, Ko WJ, Yu HY, Huang SC, Wang SS, Lin FY, Chu SH, Chen YS: Extracorporeal membrane oxygenation for perioperative cardiac allograft failure. ASAIO J 2006;52:100-103.
Arpesella G, Loforte A, Mikus E, Mikus PM: Extracorporeal membrane oxygenation for primary allograft failure. Transplant Proc 2008;40:3596-3597.
Madershahian N, Nagib R, Wippermann J, Strauch J, Wahlers T: A simple technique of distal limb perfusion during prolonged femoro-femoral cannulation. J Card Surg 2006;21:168-169.
Li YW, Rosenblum WD, Gass AL, Weiss MB, Aronow WS: Combination use of a TandemHeart with an extracorporeal oxygenator in the treatment of five patients with refractory cardiogenic shock after acute myocardial infarction. Am J Ther 2013;20:213-218.
Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson-Hansen C, Blackstone EH, Cosgrove DM 3rd: Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg 2001;122:92-102.
Chamogeorgakis T, Lima B, Shafii AE, Nagpal D, Pokersnik JA, Navia JL, Mason D, Gonzalez-Stawinski GV: Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2013;145:1088-1092.
Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, Mohr FW: Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 2010;139:302-311.
Aiyagari RM, Rocchini AP, Remenapp RT, Graziano JN: Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit. Crit Care Med 2006;34:2603-2606.
Koeckert MS, Jorde UP, Naka Y, Moses JW, Takayama H: Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support. J Card Surg 2011;26:666-668.
Madershahian N, Liakopoulos OJ, Wippermann J, Salehi-Gilani S, Wittwer T, Choi YH, Naraghi H, Wahlers T: The impact of intraaortic balloon counterpulsation on bypass graft flow in patients with peripheral ECMO. J Card Surg 2009;24:265-268.
Bisdas T, Beutel G, Warnecke G, Hoeper MM, Kuehn C, Haverich A, Teebken OE: Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg 2011;92:626-631.
Gander JW, Fisher JC, Reichstein AR, Gross ER, Aspelund G, Middlesworth W, Stolar CJ: Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem. J Pediatr Surg 2010;45:2136-2140.
Navia JL, Atik FA, Beyer EA, Ruda Vega P: Extracorporeal membrane oxygenation with right axillary artery perfusion. Ann Thorac Surg 2005;79:2163-2165.
Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM, Jorde UP, Naka Y: Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant 2013;32:106-111.
Wang J, Han J, Jia Y, Zeng W, Shi J, Hou X, Meng X: Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg 2009;88:1897-1903.
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