Complicações arteriais associada à utilização de ECMO-VA: Estudo retrospetivo e revisão da literatura

Abstract

Introduction: VA-ECMO is increasingly adopted in Europe for managing critical heart diseases, with the Extracorporeal Life Support Organization (ELSO) reporting a total of 5,637 procedures over the last five years. Despite its life-saving potential, the occurrence of arterial complications remains a significant concern, with a global incidence of 17.8% and a notable impact on morbidity and mortality rates. Aims: Assess the prevalence and impact of arterial complications among patients undergoing ECMO-VA at the ULSSJ, focusing on the identification of frequent complications, predisposing factors, associated mortality, and the effect on clinical outcomes. Methods: We performed a retrospective cohort study between January 2017 and December 2023. Data were collected on demographics, clinical background, VA-ECMO specifics (cannulation type, decannulation method, duration), and outcomes (hospital stay, mortality, additional interventions, post-hospital complications). The variables under study were obtained SClínico® data from patient records and medical databases for individuals who underwent arterial intervention associated with VA-ECMO use. Statistical analysis was performed using IBM SPSS Statistics®. We completed our study with a literature review using the databases PubMed and Scopus were utilized, employing keywords (MeSH). The focus was on articles addressing arterial complications in ECMO-VA, associated cannulation, mortality, outcomes and interest variables. Further refinement was achieved by selecting high scientific value articles classified as Q1 and Q2 according to the Scimago Journal & Country Rank to enrich the project. Results: Out of 212 patients, the study found a 26% (61) incidence of arterial complications among VA-ECMO patients, with an average (SD) of ages 45.59 (15.23) years, and 57.4% (N=35) of these were women. Ischemic complications (32,8%, N=20) and femoral pseudoaneurysms (29,5%, N=18) were most prevalent. Factors like diabetes mellitus (DM), hypertension (HTA), and active smoking were positively correlated with adverse limb and cardiac events (MALE, MACE). The median VA-ECMO duration for deceased patients was significantly higher, suggesting a correlation between extended VA-ECMO support and increased mortality. Conclusions: We observed that arterial complications in patients undergoing VA-ECMO can have a considerable influence on clinical outcomes at ULSSJ. Identifying at-risk patients through predisposing factors like DM, HTA, and smoking habits is crucial for early intervention and management strategies. Future research should focus on prospective analyses to further elucidate these relationships and develop targeted prevention and treatment protocols.