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. 2020 Oct;35(10):2512-2521.
doi: 10.1111/jocs.14758. Epub 2020 Aug 13.

Clinical predictors of in-hospital mortality in venoarterial extracorporeal membrane oxygenation

Navin G Vigneshwar  1 , Patrick D Kohtz  1 , Mark T Lucas  1 , Michael Bronsert  2 , Michael J Weyant  1 , Muhammad F Masood  3 , Akinobu Itoh  3 , Jessica Y Rove  1 , Thomas B Reece  1 , Joseph C Cleveland  1 , Jay D Pal  1 , David A Fullerton  1 , Muhammad Aftab  1
Affiliations

Clinical predictors of in-hospital mortality in venoarterial extracorporeal membrane oxygenation

Navin G Vigneshwar et al. J Card Surg. 2020 Oct.

Abstract

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is utilized as a life-saving procedure and bridge to myocardial recovery for patients in refractory cardiogenic shock. Despite technical advancements, VA-ECMO retains high mortality. This study aims to identify the clinical predictors of in-hospital mortality after VA-ECMO to improve risk stratification for this tenuous patient population.

Methods: The REgistry for Cardiogenic Shock: Utility and Efficacy of Device Therapy database is a multicenter, observational registry of ECMO patients. From 2013 to 2018, 789 patients underwent VA-ECMO. Bivariate analysis was performed on more than 300 variables regarding their association with in-hospital mortality. Logistic regression analyses were performed with variables chosen based upon clinical and statistical significance in the bivariate analysis. Tests were considered significant at a two-sided P < .05.

Results: Although 63.5% patients were successfully weaned from VA-ECMO, in-hospital mortality was 57.9%. Nonsurvivors were older (P < .0001), had higher body mass index (P = .01), higher rates of hypertension (P = .02), coronary artery disease (P = .02), chronic obstructive pulmonary disease (P = .02), chronic liver disease (P = .008), percutaneous coronary intervention (P = .02), and surgical revascularization (P = .02). Multivariate predictors for in-hospital mortality include older age (odds ratio [OR], 1.019; P = .007), cardiac arrest (OR, 2.76; P = .006), chronic liver disease (OR, 8.87; P = .04), elevated total bilirubin (OR, 1.093; P < .0001), and the presence of a left ventricular vent (OR, 2.018; P = .03). Pre-ECMO sinus rhythm was protective (OR, 0.374; P = .006).

Conclusions: In a large study of recent VA-ECMO patients, in-hospital mortality remains significant, but acceptable given the severe pathology manifested in this population. Identification of pre-ECMO predictors of mortality helps stratify high-risk patients when deciding on ECMO placement, prolonged support, and prognosis.

Keywords: cardiogenic shock; early rescue; extracorporeal membrane oxygenation; heart failure; in-hospital Mortality; veno-arterial extracorporeal membrane oxygenation.

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References

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