Abstract 11819: Impact of Dynamic Changes of Elevated Bilirubin on Survival in Patients on Veno-Arterial Extracorporeal Life Support for Acute Circulatory Failure

Abstract

Introduction: Veno- arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure by providing immediate gas exchange and peripheral tissue perfusion. Parameters and data on when to ideally wean circulatory support are limited. Hypothesis: Bilirubin levels may serve as indicator for readiness to wean ECLS. The purpose of this study was to evaluate the impact of dynamic changes of elevated bilirubin levels on survival in a large patient population on ECLS. Methods: We reviewed 502 consecutive cases of ECLS from 2007 to 2015. Bilirubin levels were recorded before implantation and then daily until six days after explantation. Bilirubin levels were statistically correlated with the primary outcome parameter 30-day survival and the secondary outcome parameters successful weaning and non-survival on ECLS. A multivariate regression analysis was performed to identify independent risk factors. Boxplots were generated to visualize dynamic changes in bilirubin levels. Results: Reason for ECLS was cardiac arrest with ongoing resuscitation in 230 (45.8%), low cardiac output in 174 (34.7%) and inability to wean off cardiopulmonary bypass in 98 (19.5%) patients. 307 (61.2%) patients were weaned off ECLS, however, only 206 (41.0%) ultimately survived 30 days. Mean duration of ECLS was 3 (2-6) days, and survivors received significantly longer ECLS (5 vs 3 days, p < 0.001 ). Survivors had significantly lower bilirubin levels initially and on day 1 ( p = 0.003 and p = 0.013 ). Bilirubin started to rise notably from day 2 in all patients. In survivors bilirubin levels had trended down on the day of ECLS explantation and stayed at an acceptable level. However, in weaned patients and nonsurvivors bilirubin levels remained above baseline or even continued to rise during the recorded period. Conclusion: Down trending bilirubin levels on ECLS indicate improved chances of survival and may warrant weaning off support in hemodynamically stable patients.