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

Abstract 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.