Abstract 11973: Clinical Outcome and Predictors of Short-term Mortality in Cardiogenic Shock Treated With Venous-arterial Extracorporeal Membrane Oxygenation: Results From the Japanese Circulation Society Cardiovascular Shock Registry

Abstract

Introduction: Venous-arterial extracorporeal membrane oxygenation (ECMO) should be considered as a means of rescuing patients with refractory cardiogenic shock and cardiac arrest. Few data are available regarding predicting the outcome of patients with cardiogenic shock treated with ECMO. The aim of this study was to investigate the outcomes of patients with cardiogenic shock assisted by ECMO and to identify the predictors of 30-day mortality. Methods: The Japanese Circulation Society Cardiovascular Shock registry is a prospective, observational, multi-center, cohort study. Between May 2012 and June 2014, a total of 980 patients with cardiovascular shock were enrolled from 82 centers in Japan. Finally, 162 patients (mean age 60.2±14.7 years, 81.5% male) required ECMO and completing 30-day follow-up were analyzed. The primary endpoint was all-cause death at 30 days. Results: Of 162 patients, 80 (49.7%) were shock after return of spontaneous circulation (ROSC) and 102 (63%) had acute coronary syndrome (ACS). The 30-day mortality overall, the non-shock after ROSC group, and the ACS group were 69.1%, 59.3%, and 68.6%, respectively. The causes of death were heart failure in 30 patients (26.8%), multiple organ failure in 49 (43.8%), respiratory failure in 2 (1.8%), sepsis in 2 (1.8%), arrhythmia in 12 (10.7%), neurological death in 8 (7.1%), and others in 9 (7.6%). On multivariate analysis, neurological status on admission (odds ratio 2.188, 95% confidence interval 1.23-3.66, p=0.007) was an independent predictor of all cause death at 30-days. Conclusion: Patients with cardiovascular shock who required ECMO demonstrated high mortality. Neurological status was an independent predictor of 30-day mortality.