Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. Methods: We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. Results: The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors’ blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p < 0.001]. Fewer survivors’ 24 hours and total chest drainage was over 1000 mL, and the rate of re-exploration as well as red blood cell and platelet transfusion were lower in survivors. In multivariate analysis, female, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and 24 hours chest drainage ⩾ 1000 mL were risk factors of early mortality. Conclusions: By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

Assessment of Nutritional Risk Scores (the Nutritional Risk Screening 2002 and Modified Nutrition Risk in Critically Ill Scores) as Predictors of Mortality in Critically Ill Patients on Extracorporeal Membrane Oxygenation

“…7 The in-hospital mortality in venovenous (VV) ECMO mode ranged from 21% to 37%, whereas the mortality in venoarterial (VA) ECMO mode fluctuated from 40% to 60%. [8][9][10] Meanwhile, patients treated with ECMO often experience complications such as stroke, acute kidney injury (AKI), bleeding, and thrombotic events. [11][12][13] Nutritional status is associated with intensive care unit (ICU) stay and mortality and is increasingly recognized as a modifiable risk factor for the clinical outcome of critically ill patients.…”

“…7 The in-hospital mortality in venovenous (VV) ECMO mode ranged from 21% to 37%, whereas the mortality in venoarterial (VA) ECMO mode fluctuated from 40% to 60%. 8–10 Meanwhile, patients treated with ECMO often experience complications such as stroke, acute kidney injury (AKI), bleeding, and thrombotic events. 11–13…”

A Nationwide Three-Month Education Program for Venoarterial Extracorporeal Membrane Oxygenation

“…ECMO education programs may expand the availability of this treatment to meet growing needs ( 3 ). Fuwai Hospital is a national center for cardiovascular disease in China, and it has provided ECMO support since 2004 ( 4 , 5 ). In 2019, Fuwai hospital launched a three-month education program for venoarterial (V-A) ECMO that recruited participants from all over the nation.…”