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. 2019 Nov/Dec;65(8):781-787.
doi: 10.1097/MAT.0000000000000898.

Predictors of Survival for Patients with Acute Decompensated Heart Failure Requiring Extra-Corporeal Membrane Oxygenation Therapy

A Reshad Garan  1 , Waqas A Malick  1 , Marlena Habal  1 , Veli K Topkara  1 , Justin Fried  1 , Amirali Masoumi  1 , Aws K Hasan  1 , Dimitri Karmpaliotis  1 , Ajay Kirtane  1 , Melana Yuzefpolskaya  1 , Maryjane Farr  1 , Yoshifumi Naka  2 , Dan Burkhoff  1 , Paolo C Colombo  1 , Paul Kurlansky  2 , Hiroo Takayama  2 , Koji Takeda  2
Affiliations

Predictors of Survival for Patients with Acute Decompensated Heart Failure Requiring Extra-Corporeal Membrane Oxygenation Therapy

A Reshad Garan et al. ASAIO J. 2019 Nov/Dec.

Abstract

Chronic systolic heart failure (HF) with acute decompensation can result in cardiogenic shock (CS) requiring short-term mechanical circulatory support. We sought to identify predictors of survival for acute decompensated HF (ADHF) patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients >18 years old treated at our institution with VA-ECMO from 2009 to 2018 for ADHF with CS were studied. Demographic, hemodynamic, and echocardiographic data were collected. The primary outcome was survival to discharge. Fifty-two patients received VA-ECMO for ADHF with CS; 24 (46.2%) survived. Seventeen (32.7%) had suffered cardiac arrest, and 37 (71.2%) were mechanically ventilated. Mean lactate was 4.33 ± 3.45 mmol/L, and patients were receiving 2.7 ± 1.2 vasopressor/inotropic infusions at ECMO initiation; these did not differ significantly between survivors and nonsurvivors. Pre-ECMO cardiac index was 1.84 ± 0.56L/min/m and 1.94 ± 0.63L/min/m in survivors and nonsurvivors, respectively (p = 0.57). In multivariable analysis, only diabetes mellitus (DM; OR, 13.25; CI, 1.42-123.40; p = 0.02) and mineralocorticoid receptor antagonist use (OR, 0.12; CI, 0.02-0.78; p = 0.03) were independent predictors of mortality. Nineteen (79.2%) survivors required durable ventricular assist device. Among ADHF patients receiving VA-ECMO, DM is a powerful predictor of outcomes while markers of clinical acuity including hemodynamics, vasopressor/inotrope use, and lactate are not. The vast majority of survivors required durable left-ventricular assist devices.

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Figures

Figure 1.
Figure 1.
Patient Outcomes. ADHF, acute decompensated heart failure; VA-ECMO, veno-arterial extra-corporeal membrane oxygenation; LVAD, left ventricular assist device.
Figure 2.
Figure 2.
Kaplan–Meier Survival Estimates After ECMO Implantation Among Diabetic and Non-Diabetic Patients. ECMO, extra-corporeal membrane oxygenation.
Figure 3.
Figure 3.
1–Year Kaplan–Meier Survival Estimates Among Patients Receiving Durable Left Ventricular Assist Device.
See this image and copyright information in PMC

References

    1. Goldberg RJ, Makam RC, Yarzebski J, McManus DD, Lessard D, Gore JM. Decade-Long Trends (2001–2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes. 2016;9:117–25. - PMC - PubMed
    1. Stretch R, Sauer CM, Yuh DD, Bonde P. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol. 2014;64:1407–15. - PubMed
    1. Rose EA, Gelijns AC, Moskowitz AJ, et al. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study group. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001;345:1435–1443. - PubMed
    1. Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009;361:2241–2251. - PubMed
    1. Rogers JG, Aaronson KD, Boyle AJ, et al. Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J Am Coll Cardiol. 2010;55:1826–34. - PubMed

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