Methods: A total of 152 adult subjects who received VA-ECMO (>24 hours) for PCS in our hospital were consecutively included. Baseline characteristics were compared between survivors with non-survivors, and logistic regression was performed to identify predictive factors for in-hospital mortality.
Results: The mean age of the subjects was 49.5±14.1 years. The main surgical procedures were heart transplantation (32.2%), coronary artery bypass graft (17%) and valvular surgery (11.8%). Intra-aortic balloon pumping(IABP) was initiated concurrently with ECMO in 32.2% subjects and sequentially in 18.4% subjects. The ECMO weaning rate was 56.6%, and the in-hospital mortality was 52.0%. When compared with non-survivors, survivors had less hypertension (15.1% vs. 35.4%, p=0.004), pre-ECMO secondary thoracotomy (19.2% vs. 39.2%, p=0.007), pre-ECMO cardiac arrest/ventricular fibrillation (11.0% vs. 34.2%, p=0.001), bedside implantation of ECMO (11.0% vs. 41.8%, p<0.001), and more transplant procedure (45.2% vs. 20.3%, p=0.001), concurrent IAPB initiation with ECMO (41.1% vs. 24.1%, p=0.025). Multivariate logistic regression indicated concurrent IABP initiation with ECMO was the only independent protective factor for in-hospital mortality (OR=0.375, p=0.041, 95% CI: 0.146-0.963). Concurrent IABP initiation with ECMO had less need for continuous renal replacement therapy (30.6% vs. 49.3%, p=0.039) and less neurological complications (8.2% vs. 22.7%, p=0.035), but more thrombosis complications (18.4% vs. 2.7%, p=0.007).
Conclusion: Concurrent initiation of IABP with ECMO provides better short-term survival for PCS, with reduced peripheral perfusion complications.