Outcome after veno‐arterial extracorporeal membrane oxygenation in elderly patients: A 14‐year single‐center experience. Issue 4 (14th November 2022)

• Record Type: Journal Article
• Authors: Provaznik, Zdenek; Philipp, Alois; Müller, Thomas; Kostiantyn, Kozakov; Lunz, Dirk; Schmid, Christof; Floerchinger, Bernhard
• Is Part Of: Artificial organs. Volume 47:Issue 4(2023)
• Page Start: 740
• Page End: 748
• Publication Date: 2022-11-14
• Subjects: extracorporeal membrane oxygenation -- long‐term outcome -- low cardiac output -- resuscitation -- survival; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.14452
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: Background: Use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) in elderly patients is controversial because of presumed poor outcome. Our primary aim was to determine the influence of advanced age on short‐ and long‐term outcome; the secondary aim was to analyze risk factors for impaired outcome. Methods: Between January 2006 and June 2020, 645 patients underwent VA‐ECMO implantation in our department. The patients were categorized into four groups:<50, 50–59.9, 60–69.9 and ≥70 years old. Data were retrospectively analyzed for short‐ and long‐term outcome. Risk factors for in‐hospital mortality and mortality during follow‐up were assessed using multivariate regression analysis. Results: VA‐ECMO support duration was comparable in all age groups (median 3 days). Weaning rates were 60.8%/ n = 104 (<50 years), 51.4%/ n = 90 (50–59.9 years), 58.8%/ n = 107 (60–69.9), and 67.5%/ n = 79 (≥70, p = 0.048). Hospital mortality was highest in the patients aged 50–59.9 years (68%/ n = 119), but not in the elderly patients (60–69.9, ≥70:62.1%/ n = 113, 58, 1%/ n = 68). At discharge, the cerebral performance category scores were superior in the patients <50 years. Multivariate logistic regression analysis revealed chronic kidney failure requiring hemodialysis, duration of cardiopulmonary resuscitation, and elevated blood lactate levels before VA‐ECMO, but not age as predictors of in‐hospital mortality. Cox's regression disclosed age as relevant risk factor for death during follow‐up. The patients' physical ability was comparable in all age groups. Conclusion: VA‐ECMO support should not be declined in patients only because of advanced age. Mortality and neurological status at hospital discharge and during follow‐up were comparable in all age groups. Abstract : Between January 2006 and June 2020, 645 patients underwent VA‐ECMO implantation. Patients were categorized into four groups: <50, 50–59.9, 60–69.9 and ≥70 years old. In‐hospital mortality and neurological status at hospital discharge and during follow‐up were comparable in all groups. VA‐ECMO support should not be declined in patients only due to advanced age.