Background: Veno-Arterial Extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiopulmonary support in the setting of refractory cardiogenic shock. Mechanical ventilation and sedation often accompanies VA-ECMO support and carry the increased risk of ventilator associated pneumonia, increased sedation burden often leading to delirium and debility. Prior small studies have demonstrated safety and feasibility of VA-ECMO without mechanical ventilation (Awake VA-ECMO).

Methods: Retrospective chart review of patients placed on VA-ECMO from 2018-2023 done and patients on awake ECMO were identified. Clinical data were collected.

Results: 11 “Awake VA-ECMO” patients were identified; 6 (54.5%) male. Average age at cannulation 53.7 years. Comorbidities included: CAD 4 (36.3%), HFrEF 6 (54.5%) CKD 3 (27.2%), PAH 1 (9.09%). Indication for VA-ECMO was refractory cardiogenic shock secondary to: Nonischemic Cardiomyopathy 4 (36.3%), VT/VF 2 (18.2%), Ischemic Cardiomyopathy 1 (9.09%), Acute Cor Pulmonale 1 (9.09%), Acute Myocarditis 1 (9.09%), Undifferentiated cardiogenic shock 2 (18.2%).

Average ECMO duration 5.09 days (range 1-11 days)

Complications: Renal replacement therapy 4 (36.3%), Pneumonia 4 (36.3%), Bacteremia 4 (36.3%), Right ventricular assist device Required 5 (45.5%), and DVT(9.09%).

5 (45.5%) patients underwent left ventricular assist device placement, 2 (9.09%) underwent heart transplantation, 1 (9.09%) transferred to another institution, 2 (18.2%) patients recovered and 1 (9.09%) passed away.

Average duration of hospitalization post decannulation 14.7 days (range 2-28 days)

Discharge disposition: Home 5, Inpatient rehab 4, Transfer to another institution 1, death 1.

Conclusion: Awake VA-ECMO is safe and feasible with proper patient selection. Further longitudinal studies are needed validate presumed risk reductions.