Background:
Extra-corporeal membrane oxygenation (ECMO) is increasingly being used as a life-saving bypass technique for patients whose acute cardiopulmonary failure is potentially reversible and refractory to conventional care. Prognostic data for ECMO among diverse patients are limited. The purpose of this study was to evaluate the association between age (≥ 65 vs. <65 years) and 1-year mortality after ECMO, adjusted for confounders.
Methods:
This was a retrospective cohort analysis of 131 consecutive adult patients (28% ≥65 years old, 26% racial/ethnic minority, 38% female) enrolled in an ECMO database who received veno-arterial ECMO at an academic medical center between 2004-2013. Demographics, comorbid conditions, admission characteristics, and mortality status at 1 year were obtained from the hospital clinical information system, updated monthly with Social Security Death Index data. Univariate and multivariate adjusted Cox proportional hazard analyses were conducted to evaluate the associations between age strata and post-ECMO mortality.
Results:
The 1-year mortality rate post-ECMO was 56% (n=73). Age ≥ 65 vs. <65 was significantly associated with increased mortality (HR=1.8; 95% CI=1.1-2.9); the association was attenuated and did not retain statistical significance after adjustment for comorbid conditions (HR=1.4; 95% CI=0.8-2.5). Figure 1 illustrates mortality risk by age strata adjusted for: a) demographics (race/ethnicity and sex) and b) demographics and comorbid conditions. Race/ethnicity and sex were not significantly associated with 1-year mortality. Significant predictors of mortality included: Medicaid vs. other health insurance status, history of coronary artery bypass graft surgery, peripheral vascular disease, renal failure, dialysis, and shock (p<0.05).
Conclusion:
Older age (≥65) was not independently associated with 1-year mortality among ECMO patients, but may indicate higher comorbidity, which was associated with increased risk of mortality in the year following ECMO.
Hemodynamic Effects of Left-Atrial Venous Arterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO)
