Abstract 14041: The Association of Left Heart Pressures and Survival After Starting Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Abstract

Introduction: Despite the ability to provide full hemodynamic support in patients with refractory cardiogenic shock (CS), a potential limitation is elevated intracardiac filling pressures from increased left ventricular afterload. There is a paucity of data regarding the correlation of left atrial pressures (LAP) with outcomes. Hypothesis: Our objective was to determine association between LAP and survival for patients with refractory CS after 24 hours of VA ECMO support. Methods: Cohort analysis among 10,906 patients ≥18yrs from the Extracorporeal Life Support Organization (ELSO) Registry (2015 - 2020), with refractory CS on VA ECMO. LAP values were defined as pulmonary capillary wedge pressure (PCWP) or pulmonary arterial diastolic pressure (PAD) values if PCWP was missing. The exposure was LAP values at 24 hours on VA ECMO support. Our primary outcome was survival to discharge. We used multivariate regression, adjusted for age, and the following pre-ECMO variables: PaO2/FiO2, pH, mean arterial blood pressure (MAP), and SCAI classification; and the following variables after 24 hours of support: pH, MAP; and year. Results: Median age was 57 [IQR,46; 65] years old and 31% were females. Thirty two percent (n=3,465) presented with acute myocardial infarction, 29% (n=3,112) with acute heart failure and 1% (n=965) with both etiologies. Invasive hemodynamic monitoring was measured in 33% (n=3608) of patients. Median LAP was 18mmHg [IQR,14; 23]. Every 1 mm Hg incremental of LAP on support was associated with lower survival (aOR 0.97 [95% CI 0.95 to 0.98]; p<0.001), and 30% increase in duration of VA-ECMO support (beta-coeff 1.37 [95% CI 0.42 to 2.3]; p=0.005). Conclusions: Reduced LAP may be associated with higher adjusted hospital survival in patients with refractory CS on VA-ECMO. These findings merit further investigation and prospective validation to assess the relationship between hemodynamically tailored management and outcomes in this patient population.