Next Level ECLS-Assisted Transport: Venoarterial Support

Objectives: Extracorporeal life support (ECLS) assisted transport is an established method for critically ill patients. However, patients requiring venoarterial (v-a) support still represents a challenge. We therefore ought to analyze our experience with v-a ECLS-supported transport at our clinic.

Methods: We retrospectively analyzed all patients receiving “transport” v-a ECLS support at our institute. From 2012 to 2018, we performed a total of 980 ECLS implantations. Of those, 245 were external ECLS implantations with 109 v-a ECLS (group 1). We compared these patients to our in-house v-a ECLS patients (n = 605, group 2).

Results: Mean age of the external ECLS group was 47 years (± 20, range: 0–75 years vs. 47 years, ± 21, range: 0–75 years, p = n.s.) with 63% male (vs. 64%, p = n.s.). Indications were heterogenous with (the most common only for group 1): 34% were acute myocardial infarction, 10% were acute lung embolia, 10% were myocarditis, 15% were acute decompensated heart failure, 9% were decompensated idiopathic pulmonary hypertension, and 9% were mechanical complicated acute myocardial infarctions (ventricular septal defects, mitral valve insufficiency, etc.). Ten patients (9 vs. 10% group 2, p = n.s.) received awake ECLS implantation. Time of admission to hospital until ECLS support was 36 hours (±  63 hours) vs. (34 hours ± 22 hours group 2). ECMO score (SAVE) was −3.9 (± 4.2) vs. (−1.3 ± 4.5 group 2, p = 0.03). ECLS support duration was 7.8 days (± 6.6 days) vs. 6.9 ± 11 days, p = 0.053). 11% of patients showed vascular complications requiring surgical intervention (vs. 4.6% group 2, p < 0.01). 37% of patients died on ECLS support (vs. 43% group 2, p = n.s.), and 30-day mortality was 46% (vs. 46%, p = n.s., group 2 ) with 10% secondary failure rate (death after ECLS weaning) (vs. 6% for group 2, p = n.s.).

Conclusion: Patients requiring v-a ECLS represent a heterogenous patient group and need an interdisciplinary team effort of care. v-a ECLS-assisted transport can be achieved with a low complication rate and comparable outcomes, despite a worse ECMO score, in-house ECLS implantations therefore justifying these logistical challenging and time-consuming transports.