Utilization and outcomes of V‐AV ECMO: A systematic review and meta‐analysis.

Background: Veno‐arterial–venous extracorporeal membrane oxygenation (V‐AV ECMO) is a less commonly used configuration of ECMO. We sought to understand the indications, utilization patterns, and outcomes of V‐AV ECMO by quantitatively pooling the existing evidence from the literature. Methods: Electronic search was performed to identify all relevant studies reporting V‐AV ECMO usage. Five studies comprising 77 patients were selected and cohort‐level data were extracted for further analysis. Results: Mean patient age was 61 (95% CI: 55.2, 66.5) years and 30% (23/77) were female. The majority of cases [91% (70/77)] were transitioned to V‐AV ECMO from another pre‐existing ECMO configuration: V‐A ECMO in 55% (42/77) vs. V‐V ECMO in 36% (28/77), p = 0.04. Only 9% (7/77) of cases were directly placed on V‐AV ECMO. The mean duration of hospital stay was 42.3 (95% CI: 10.5, 74.2) days, while ICU mortality was 46% (29, 64). Transition to durable left ventricular assist device was performed in 3% (2/64) of patients, while 3% (2/64) underwent heart transplantation. V‐AV ECMO was successfully weaned to explantation in 33% (21/64) of patients. Conclusion: V‐AV ECMO is a viable option for optimizing cardiopulmonary support in selected patients. Survival to weaning or bridging therapy appears comparable to more common ECMO configurations. [ABSTRACT FROM AUTHOR]