Hospital outcomes after emergent peripheral veno-arterial extracorporeal membrane oxygenation in adult patients presenting with cardiogenic shock

Abstract

Background: Emergent peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used frequently to support patients with refractory cardiogenic shock with variable rates of complications. We retrospectively analyzed adult patients who received peripheral VA-ECMO support between 2015 and 2019 at our tertiary care hospital. Results: Sixty five patients with a mean age of 37.9 ± 14.9 years, mostly males (70.8%), were supported with femoral VA-ECMO with a median duration of 8 (IQR: 3–40) days. Hospital mortality occurred in 29 (44.6%) patients. Complications included acute kidney injury (AKI) in 39 (60%), acute cerebral strokes in 13 (20%), gastrointestinal bleeding in 14 (21.5%) and acute limb ischemia in 21 (32.3%) patients. Non-survivors had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores and significantly increased rates of acute kidney injury, renal replacement therapy, ischemic cerebral strokes, cannulation site exploration for bleeding, atrial fibrillation and anticoagulation discontinuation. Multivariable regression analysis revealed significant Odds Ratios (OR), 95% Confidence Intervals (CI) of hospital mortality with: increasing SOFA scores after 48 hours (2.15, 1.441–3.214, p < 0.001), atrial fibrillation (11.351, 1.354–83.222, p = 0.025) and hyperlactatemia (2.74, 1.448–6.719, p = 0.016). Conclusion: High mortality and frequent morbidities due to emergent peripheral VA-ECMO should be considered before initiation for cardiogenic shock. According to our results, increasing trend of SOFA scores, atrial fibrillation and progressive hyperlactatemia are independent predictors of hospital mortality of peripheral VA-ECMO.