Prognostic Factors of Survival in Veno-Arterial ECMO Patients: A Multivariable Logistic Regression Analysis

Authors

  • Andrew Jones BA, 3rd year medical student. University of Rochester School of Medicine and Dentistry. Rochester, NY.
  • George Olverson IV BS, 3rd year medical student. University of Rochester School of Medicine and Dentistry. Rochester, NY.
  • Wayne Wong BS, 4th year medical student. University of Rochester School of Medicine and Dentistry. Rochester, NY.
  • Rohun Bhagat MD, Recent Alumni. University of Rochester School of Medicine and Dentistry. Rochester, NY.
  • Clauden Louis MD, Chief Resident, Division of Cardiac Surgery, Department of Surgery. University of Rochester Medical Center. Rochester, NY

DOI:

https://doi.org/10.5195/ijms.2023.1557

Keywords:

Survival, Veno-Arterial ECMO, Multivariable Logistic Regression Analysis, Critical care, Resource allocation, Ethical discussions, Patient selection, SAVE score, Hemolysis, Inflammation, Risk prediction model, Mortality, Smoking, Dialysis status, BMI (Body Mass Index), Atrial fibrillation, Hypertension, Diabetes mellitus, COPD (Chronic Obstructive Pulmonary Disease), History of cardiac arrest, Retrospective study, Single-center study, Provider bias, Stepwise model selection, Logistic regression, Clinical endpoints, Explantation

Abstract

Background: Several models exist to predict mortality in patients on Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO).  Whether expanded demographic data points have prognostic implications is less understood. This study assessed the prognostic value of demographics in patients on VA-ECMO.

Methods: This retrospective cohort study investigated 410 patients who received VA-ECMO.  Survival to hospital discharge, survival to intensive care unit discharge and survival to ECMO explantation were examined. A multivariable logistic regression was performed incorporating 11 demographic variables.


Results: 44% (181/410) of patients survived to ECMO explant, 37% (152/410) of patients survived to ICU discharge, and 36% (146/410) of patients survived to hospital discharge. There was an increase in odds of survival to hospital discharge in patients who were less than 55 years old (Odds Ratio (OR) = 3.91 [95% Confidence Interval (CI) 2.35-6.49]). There was a decrease in odds of survival to hospital discharge in patients who had a prior cardiac arrest (OR = 0.35 [95% CI 0.20-0.63]). Patients who survived to hospital discharge less frequently had a history of smoking (51% vs 65%, respectively; p=0.008), and were younger compared to those who did not survive (51.4+/- 14.03 vs 57.3+/- 16.54).

Conclusion: Age less than 55 years old was a prognostic indicator of survival to hospital discharge following VA-ECMO, while history of smoking, history of dialysis, and history of cardiac arrest were associated with mortality. Sex, BMI, atrial fibrillation, hypertension, DM, and COPD were not significant indicators. These data may help guide optimal patient selection for VA-ECMO support.

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References

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ECMO Course Flowsheet. Prognostic Factors of Survival in Veno-Arterial ECMO Patients

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Published

2023-12-04

How to Cite

Jones, A., Olverson IV, G., Wong, W., Bhagat, R., & Louis, C. (2023). Prognostic Factors of Survival in Veno-Arterial ECMO Patients: A Multivariable Logistic Regression Analysis. International Journal of Medical Students, 11(4), 285–293. https://doi.org/10.5195/ijms.2023.1557

Issue

Vol. 11 No. 4 (2023)

Section

Original Article

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Copyright (c) 2023 Andrew S Jones, George Olverson IV, Wayne Wong, Rohun Bhagat, Clauden Louis

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