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Abstract

Introduction: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is a rescue modality in refractory circulatory failure or severe respiratory failure, with a mortality rate of approximately 50%. However, little evidence exists regarding in-hospital mortality after discontinuing VA-ECMO. Hypothesis: The present study was conducted to investigate for in-hospital mortality of patients after discontinuing VA-ECMO. Methods: Between October 2008 and June 2012, patients undergoing VA-ECMO due to refractory postcardiotomy shock, cardiogenic shock and/or pulmonary dysfunction were screened, and those successfully weaned from VA-ECMO were included. Patients <18yo, or subsequently placed on a left ventricular assist device and/or undergoing transplantation were excluded. Results: Of 84 patients who underwent VA-ECMO, 50 patients were successfully weaned. There were 21(42%) surgical and 29 (58%) medical patients. The average age (± SD) was 65 ± 11yr, 80% were male, median hospital stay was 32.5d (range 19-61), and mean APACHE II score was 28.6 ± 7.2. After discontinuing VA-ECMO, 34 patients survived and 16 died. The median duration from discontinuing VA-ECMO to death was 9.5d (range 4.5-14.8). Causes of mortality included sepsis in 5 (31%), hepatic failure in 3 (19%), low cardiac output syndrome in 2 (13%), respiratory failure in 1 (6%), and other in 5 (31%). Two patients died within 48 hours of discontinuation. In multiple logistic regression analyses, continuous renal replacement therapy (CRRT) during VA-ECMO (OR: 45.9, 95%, CI 3.0 – 699.7) was significantly associated with increased in-hospital mortality. Conclusions: In-hospital mortality after discontinuing VA-ECMO is 32%, which is similar to previous study (J Thorac Cardiovasc Surg. 2001; 122: 92-102). This study shows that CRRT is a significant predictor of in-hospital mortality after discontinuing VA-ECMO and the main cause of death is sepsis.