Abstract
Background
Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in critically ill patients due to a variety of underlying clinical reasons. Different methods of MCS may be applied with the venous-arterial extracorporeal membrane oxygenation (VA-ECMO) system being one of the most utilized in everyday care.
Objectives
Our aim was to determine independent predictors of mortality following VA-ECMO therapy in a large, unselected, adult, critically ill patient population requiring MCS.
Methods
Data on 181 consecutive, real-world VA-ECMO treatments have been assessed. Analysis was conducted for all subjects requiring MCS with the VA-ECMO as first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated.
Results
Overall mortality amounted to ≈65% at a median follow-up of 28 days and depended upon: glomerular filtration rate of <60 ml/min/1.73 m2 (HR: 1.53; p=0.03) and age ≥65 years (HR: 1.65; p=0.02) based on multivariate Cox regression analysis. However, prolonged ECMO time, conversion of the ECMO to longer duration MCS, diabetes, prior ACS or revascularization, reduced left ventricular ejection fraction (EF) had no effect on adverse mortality outcomes (all p>0.05). Surprisingly, neither the need for resuscitation during MCS nor any ECMO implantation indication influenced mortality by itself (p>0.05).
Conclusions
We have found that mortality in critically ill patients requiring VA-ECMO use remains very high. Decreased renal function and advanced age were found to influence mortality in our all-comers patient population, while traditional predictors of cardiovascular mortality did not have a significant effect on survival.
Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population