PROGNOSTIC FACTORS OF VENO-ARTERIAL ECMO PATIENTS: A MULTIPLE LOGISTIC REGRESSION ANALYSIS

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Several mortality prediction models exist for patients on Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), including the Survival after VA ECMO (SAVE) Score. Whether additional characteristics, such as body surface area (BSA), race, gender, Hispanic ethnicity, and dialysis history, affect mortality of VA ECMO patients are not as well understood. This study thus assessed such prognostic factors in these patients. METHODS: A retrospective single-institutional study collected all consecutive non-pediatric patients who received VA ECMO between 2016-2020. 410 patients were identified. We excluded 13 patients who were transitioned to or from VA ECMO. Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis. RESULTS: 264 (64.4%) of VA ECMO patients did not survive until hospital discharge. Median age amongst VA ECMO patients was 59 years old, and median BSA was 2.10 m2. 339 (82.7%), 55 (13.4%), and 16 (3.90%) of patients were white, black, and of other race, respectively. 13 (3.17%) were of Hispanic ethnicity and 130 (31.7%) were female. 158 (38.5%) and 31 (7.56%) had undergone a cardiotomy or heart transplant, respectively. A multiple logistic regression model assessing survival to hospital discharge was created, incorporating 11 covariates and with a model Likelihood Ratio chi-square test of 61.8 (p < 0.001). Patient age less than 55 years old was significantly associated with improved odds of survival to hospital discharge (adjusted odds ratio, 3.07; 95% confidence interval, 1.88 to 5.04). Two covariates were significantly associated with decreased odds of survival to hospital discharge: history of dialysis (adjusted odds ratio, 0.31; 95% confidence interval 0.11 to 0.99); and, if patient had a cardiac arrest (adjusted odds ratio, 0.42; 95% confidence interval 0.23 to 0.78). CONCLUSIONS: Age < 55 years old was associated with improved prognosis, while history of dialysis and presence of cardiac arrest were associated with worse prognosis. Race, gender, BSA, and history of cardiotomy or heart transplant were not significantly associated with survival to hospital discharge in this cohort of VA ECMO patients. CLINICAL IMPLICATIONS: Additional factors affecting prognosis of VA ECMO patients were identified. These variables, such as history of dialysis, can be incorporated into an existing or new risk prediction model to better assess a patient’s clinical course. In addition, certain social disparities of health, such as race and gender, were not found to be associated with VA ECMO outcomes, although more research is needed. DISCLOSURES: No relevant relationships by Rohun Bhagat, source=Web Response No relevant relationships by Jay Hwang, source=Web Response No relevant relationships by Andrew Jones, source=Web Response No relevant relationships by Clauden Louis, source=Web Response No relevant relationships by Kevin McGann, source=Web Response