Introduction: Hypertrophic cardiomyopathy (HCM), especially the obstructive variant, can lead to serious manifestations including cardiac arrest and refractory heart failure. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be a valuable tool for patients with prolonged cardiac arrest or cardiogenic shock. However, no previous reviews have studied the outcomes of HCM patients that required VA-ECMO support.
Methods: A systemic search was done across three databases to identify adult cases of HCM that were placed on ECMO of whom the outcomes were reported. The age cutoff was 16 years or older. All variants of HCM were included. Demographic data such as age and gender, as well as relevant clinical data which includes the indication of ECMO, were collected.
Results: Out of 263 abstracts screened, 111 underwent full text review. 22 studies which reported mortality outcome were included. These studies were mainly case reports, and it included 23 patients. The average age was 47 years (median:49, IQR: 16-78). 13/23 were females (57%). 3/23 of patients died, yielding an overall mortality of 13% in these studies. The most common indications of ECMO were cardiogenic shock (10/23, 43%), decompensated heart failure (5/23, 22%) and cardiac arrest (4/23, 17%).
Conclusions: Veno-arterial extramembrane oxygenation appears to be an effective modality for the management of complicated HCM especially in cases of cardiogenic shock and decompensated heart failure. It appears to improve survival related to cardiac arrest secondary to HCM, but further analyses are needed to confirm these observations.
.jpg "Yousef S. Alabrach, MD photo")
