Contemporary Use of Veno-arterial Extracorporeal Membrane Oxygenation: Insights from the Multicenter Rescue Registry

Abstract

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge. Methods and Results We created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at three high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were post-cardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% (n=290) survived to discharge, with a minority receiving durable cardiac support (LVAD [n=48] or heart transplant [n=7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (OR 1.26 [1.12-1.42]) and female sex (OR 1.44 [1.02-2.02]) and risk factors for mortality after decannulation as higher BMI (OR 1.17 [1.01-1.35]) and major bleeding while on ECMO support (OR 1.92 [1.23-2.99]). Conclusions Despite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. Optimization of outcomes will require refinements in patient selection and improvement of care delivery. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge. We created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at three high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were post-cardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% (n=290) survived to discharge, with a minority receiving durable cardiac support (LVAD [n=48] or heart transplant [n=7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (OR 1.26 [1.12-1.42]) and female sex (OR 1.44 [1.02-2.02]) and risk factors for mortality after decannulation as higher BMI (OR 1.17 [1.01-1.35]) and major bleeding while on ECMO support (OR 1.92 [1.23-2.99]). Despite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. Optimization of outcomes will require refinements in patient selection and improvement of care delivery.