Abstract 15668: Mechanical Circulatory Support With Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Results From the Extracorporeal Life Support Organization (ELSO) Registry

Abstract

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory acute cardiogenic shock is increasingly applied in adult patients. Patient age, however, represents still a controversial issue and data about VA-ECMO in elderly patients have been poorly reported in this setting. Hypothesis: The Extracorporeal Life Support Organization (ELSO) Registry was analysed to assess the in-hospital outcome of elderly patients (≥ 70 years) undergoing VA-ECMO because of acute refractory cardiogenic shock. Methods: Mean age of the total adult patient cohort (n=5,408) was 53.0±15.7 years (range 18-91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2±4.4 years, with pre-ECMO cardiac-related surgical or interventional procedures performed in 134 cases (18.9%). The mean duration of VA-ECMO in this group was 100.7± 90.9 hours (as compared to 137.7±146.1 hours, in younger group)(p<0.001). Results: Overall survival to hospital discharge was 41.4% (2,657/5,408), with 30.5% (224/735) in the elderly, and 43.1% (2,016/4,673) in younger patients (p<0.05), respectively. In terms of complications, older patients showed higher rates (p<0.001) of bleeding, of infection, acute renal failure, renal replacement therapy, and need of inotropic drugs. Conclusions: Despite higher mortality and morbidity rates as compared to younger subjects, elderly patients undergoing VA-ECMO for refractory cardiogenic shock have still an acceptable outcome in such a challenging clinical scenario, indicating that patient age should not represent an absolute contraindication in the therapeutic decision-making.