Impact of ejection fraction changes on long-term outcomes in VA-ECMO patients

Abstract

There is limited evidence regarding the association between myocardial function requiring extracorporeal membrane oxygenation (ECMO) and long-term survival rate in patients who reach hospital discharge. This study investigates the association between myocardial function parameters collected at different times from weaning from ECMO to long-term follow-up and the long-term mortality rate. This retrospective study investigates the effect of EF timing in the long-term. A cohort of 403 patients successfully weaned from veno-arterial ECMO (VA-ECMO) was identified from 1300 patients who underwent VA-ECMO between 2003 and 2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database (CGRD). The study revealed that a notable improvement in ejection fraction (EF) percentile between ECMO placement and successful weaning was significantly linked to reduced cumulative mortality as were higher EF values before discharge. However, no significant association was found between lower long-term mortality and EF change from discharge to mid-term follow-up, or the maximum EF at mid-term follow-up. Improvements in cardiac function following the use of VA-ECMO and better baseline cardiac function are associated with lower long-term mortality. The study showed that EF monitoring at ECMO insertion and before discharge can inform physicians regarding patients' long-term outcomes. EF percentile improvement from insertion to weaning could be a positive indicator of successful weaning.

Keywords: ECMO; VA; long myocardial function; term follow up.

Figure 1.

The flowchart for the inclusion and exclusion of the study patients. AMI = acute myocardial infarction, ECMO = extracorporeal membrane oxygenation, ECPR = extracorporeal cardiopulmonary resuscitation, HF = heart failure, VA = veno-arterial, VF = ventricular fibrillation, VT = ventricular tachycardia.

Figure 2.

The number of VA-ECMO and proportion of in-hospital deaths across years (A) and the distribution of indications across the study period (B). AMI = acute myocardial infarction, ECMO = extracorporeal membrane oxygenation, ECPR = extracorporeal cardiopulmonary resuscitation, HF = heart failure, VA = veno-arterial, VF = ventricular fibrillation, VT = ventricular tachycardia.

Figure 3.

The LVEF values at ECMO insertion, before discharge and the 180th day after discharge (A) and the analytic framework of the study (B). ECMO = extracorporeal membrane oxygenation, LVEF = left ventricular ejection fraction.

Figure 4.

The relationship between risk of all-cause mortality and LVEF with different definitions: the improvement from ECMO insertion to before discharge (A), the LVEF value before discharge (B), before discharge to the 180th day after discharge (C), and LVEF at the 180th day after discharge (D). ECMO = extracorporeal membrane oxygenation, LVEF = left ventricular ejection fraction.