(667) - Extracorporeal Membrane Oxygenation (ECMO) Practices for Bridging to Lung Transplantation in North America: A Multi-Center Survey

Abstract

s S247 University of Pittsburgh Medical Center, Pittsburgh, PA; 2Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; 3Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA. Purpose: Acute myocardial infarction (AMI) has been associated with higher mortality rates in the female population. The aim of this study was to evaluate gender-specific outcomes with the use of Extracorporeal Membrane Oxygenation (ECMO) as circulatory support in patients with AMI complicated by profound cardiogenic shock (CS). Methods: This retrospective review included 41 patients (32 men, 9 women) supported on veno-arterial (VA) ECMO for AMI-induced CS in a single center between July 2003 and April 2013. Comparisons were performed between males and females groups regarding demographics, risk factors for coronary artery disease, revascularization, support strategies , complications, and outcomes. Results: There were no differences in age or risk factors for coronary artery disease among the groups. Men had a higher use of intra-aortic balloon pump (IABP) during admission (96.9% vs. 66.7%, p= 0.03) but similar rates of CPR (37.5% vs. 33.3%, p= 1.00) and PCI (78.1% vs. 55.5%, p= 0.22). There were no differences in mean lactate, troponin, and liver transaminases among the groups prior to ECMO implantation (p= 0.38, p= 0.31, p= 0.15, p= 0.38). Complication rates including renal failure necessitating dialysis, sepsis, pneumonia, cerebrovascular accidents, and ischemia requiring fasciotomy or amputation were comparable among both groups, but females were more likely to suffer bleeding complications (66.7% vs. 25.0%, p= 0.04). The average time of ECMO support was 88 h (SD 78h), with no difference between groups (p= 0.23). Females showed overall lower survival to discharge (11.1% vs. 53.1%, p= 0.05). Multivariate analysis showed association of only female sex with in-hospital mortality with HR 2.86 (1.16-7.14, 95%CI, p= 0.02). Conclusion: In this single center experience ,women requiring ECMO support for AMI-CS present a significantly higher mortality risk than men.