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

Chakaramakkil MJ, Sivathasan C. ECMO and Short-term Support for Cardiogenic Shock in Heart Failure. Curr Cardiol Rep. 2018;20(10):87.

Paolone S. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature. Clin Nurs Res. 2017;26(6):747-62.

Telukuntla KS, Estep JD. Acute Mechanical Circulatory Support for Cardiogenic Shock. Methodist Debakey Cardiovasc J. 2020;16(1):27-35.

Guglin M, Zucker MJ, Bazan VM, Bozkurt B, El Banayosy A, Estep JD, et al. Venoarterial ECMO for Adults: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73(6):698-716.

Hoyler MM, Kumar S, Thalappillil R, White RS, Tam CW. VV-ECMO usage in ARDS due to COVID-19: Clinical, practical and ethical considerations. J Clin Anesth. 2020;65:109893.

Murugappan KR, Walsh DP, Mittel A, Sontag D, Shaefi S. Veno-venous extracorporeal membrane oxygenation allocation in the COVID-19 pandemic. J Crit Care. 2021;61:221-6.

Giraud R, Legouis D, Assouline B, De Charriere A, Decosterd D, Brunner ME, et al. Timing of VV-ECMO therapy implementation influences prognosis of COVID-19 patients. Physiol Rep. 2021;9(3):e14715.

Hong X, Xiong J, Feng Z, Shi Y. Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19? Int J Infect Dis. 2020;94:78-80.

Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246-56.

Chen WC, Huang KY, Yao CW, Wu CF, Liang SJ, Li CH, et al. The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department. Crit Care. 2016;20(1):336.

Smith M, Vukomanovic A, Brodie D, Thiagarajan R, Rycus P, Buscher H. Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry. Crit Care. 2017;21(1):45.

Bateman RM, Sharpe MD, Jagger JE, Ellis CG, Solé-Violán J, López-Rodríguez M, et al. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016. Crit Care. 2016;20(Suppl 2):94.

Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014;189(11):1374-82.

Orsini J, Blaak C, Yeh A, Fonseca X, Helm T, Butala A, et al. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage. J Clin Med Res. 2014;6(6):463-8.

Dalia AA, Ortoleva J, Fiedler A, Villavicencio M, Shelton K, Cudemus GD. Extracorporeal Membrane Oxygenation Is a Team Sport: Institutional Survival Benefits of a Formalized ECMO Team. J Cardiothorac Vasc Anesth. 2019;33(4):902-7.

Fitzgerald DC, Darling EM, Cardona MF. Staffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation. Crit Care Clin. 2017;33(4):863-81.

Bjelic M, Kumar N, Gu Y, Chase K, Paic F, Gosev I. Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation. J Intensive Care Med. 2022:8850666221086839.

Ayers B, Bjelic M, Kumar N, Wood K, Barrus B, Prasad S, et al. Long-term renal function after venoarterial extracorporeal membrane oxygenation. J Card Surg. 2021;36(3):815-20.

Amin F, Lombardi J, Alhussein M, Posada JD, Suszko A, Koo M, et al. Predicting Survival After VA-ECMO for Refractory Cardiogenic Shock: Validating the SAVE Score. CJC Open. 2021;3(1):71-81.

Appelt H, Philipp A, Mueller T, Foltan M, Lubnow M, Lunz D, et al. Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)-Comparison of VA- versus VV ECMO. PLoS One. 2020;15(1):e0227793.

Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care. 2016;20(1):387.

Blakeslee-Carter J, Shao C, LaGrone R, Gonzalez-Sigler I, Sutzko DC, Pearce B, et al. Vascular complications based on mode of extracorporeal membrane oxygenation. J Vasc Surg. 2022;75(6):2037-46.e2.

Malinowski D, Fournier Y, Horbach A, Frick M, Magliani M, Kalverkamp S, et al. Computational fluid dynamics analysis of endoluminal aortic perfusion. Perfusion. 2022:2676591221099809.

Galvagno SM, Jr., Pelekhaty S, Cornachione CR, Deatrick KB, Mazzeffi MA, Scalea TM, et al. Does Weight Matter? Outcomes in Adult Patients on Venovenous Extracorporeal Membrane Oxygenation When Stratified by Obesity Class. Anesth Analg. 2020;131(3):754-61.

Swol J, Buchwald D, Strauch JT, Schildhauer TA, Ull C. Effect of body mass index on the outcome of surgical patients receiving extracorporeal devices (VV ECMO, pECLA) for respiratory failure. Int J Artif Organs. 2017:0.

Muller G, Flecher E, Lebreton G, Luyt C-E, Trouillet J-L, Bréchot N, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Medicine. 2016;42(3):370-8.

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

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

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