Abstract 112: Short- and Long-term Survival of Patients Supported on Venoarterial and Veno-venous Extracorporeal Membrane Oxygenation

Abstract

Introduction: Use of both venoarterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has broadened to an expanded set of indications for supporting patients in shock, but outcome data by these indications remains limited. This study examines survival of VA and VV ECMO patients by indication. Methods: A retrospective review of adults supported by ECMO at a single center for cardiogenic shock between January 2010 - November 2018 was conducted. VA ECMO patients (n=449) and VV ECMO patients (n=91) were classified according to indication for ECMO support. Kaplan-Meier analysis was used to construct survival curves at 30 days and 1 year and compared using log-rank test. Post-hoc Tukey test was used to adjust for multiple comparisons. Results: The subgroups of indication for VA-ECMO support were Acute Pulmonary Embolism (PE, n=14), Ischemic Cardiomyopathy or Myocardial Infarction (ICM or MI, n=108), Non-Ischemic Cardiomyopathy (NICM, n=82), Post-Cardiotomy (n=129), Transplant (Tx, n=32), and Other (n=84). Kaplan-Meier estimates of survival stratified by indication at 30 days and 1 year were significant (30d: p=0.006, 1y: p=0.009, Figure 1). Multiple comparisons at 30 days and 1 year were significant for Acute PE v Post-Cardiotomy (30d: p=0.044, 1y: p=0.029), NICM v Post-Cardiotomy (30d: p=0.016, 1y: p=0.025), and Tx v Post-Cardiotomy (30d: p=0.01, 1y: p=0.022). Among VV-ECMO patients, the subgroups of indication were ARDS: Influenza (n=25), ARDS: Other Infection (n=24), and ARDS: Non-Infectious (n=42). No statistically significant difference in survival was appreciated between these indications either at 30 days (p=0.742) or 1 year (p=7.82). Conclusions: Patients who require Post-Cardiotomy VA-ECMO support have worse short- and long-term survival compared to patients who require support for Acute PE, NICM, or Transplant indications. Among VV-ECMO patients, however, no survival difference is appreciated by indication.