VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors. Issue 2 (6th November 2018)

• Record Type: Journal Article
• Authors: Fux, Thomas; Holm, Manne; Corbascio, Matthias; Lund, Lars H.; van der Linden, Jan
• Is Part Of: Artificial organs. Volume 43:Issue 2(2019)
• Page Start: 132
• Page End: 141
• Publication Date: 2018-11-06
• Subjects: Mechanical circulatory support -- Venoarterial extracorporeal membrane oxygenation -- Heart failure -- Cardiogenic shock; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13331
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: Refractory cardiogenic shock (RCS) is associated with a high mortality. Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is increasingly used as acute cardiopulmonary support but selection of VA‐ECMO candidates remains challenging. There are limited data on which pre‐VA‐ECMO variables that predict outcome. The aim of this study was to identify pre‐VA‐ECMO predictors of 90‐day mortality. We retrospectively analyzed 76 consecutive patients (median age 52; interquartile range [IQR]: 37–60) supported with VA‐ECMO due to RCS. The association between pre‐implant variables and all‐cause mortality at 90 days was analyzed with multivariable logistic regression. Main etiologies of RCS were acute myocardial infarction 51% and other AHF etiologies 49%. Cardiopulmonary resuscitation was performed in 54% of patients before initiation of VA‐ECMO. Median duration of VA‐ECMO was 5 days (IQR: 2–11). The 90‐day overall mortality was 49% and in‐hospital mortality was 50%; 46% died on VA‐ECMO, 37% were successfully weaned, 13% were bridged to heart transplantation, and 4% to left ventricular assist device. Multivariable logistic regression analysis identified arterial lactate (odds ratio [OR] per mmol/L: 1.15; 95% confidence interval [CI]: 1.06–1.24; P = 0.001) and number of inotropes and vasopressors (OR per agent: 2.14; 95% CI: 1.26–3.63; P = 0.005) as independent predictors of 90‐day mortality. In RCS patients arterial lactate level and number of inotropes and vasopressors were identified as independent pre‐VA‐ECMO predictors of 90‐day mortality. Thus, the severity of cardiogenic shock expressed as levels of lactate and vasoactive agents just before start of VA‐ECMO may be more predictive of outcome than the specific etiology of cardiogenic shock.