Survival to Hospital Discharge Rate and Factors Affecting Survival Rate of Adult Patients Under Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) Treatment in King Chulalongkorn Memorial Hospital

Abstract

Background: Nowadays, venoarterial extracorporeal membrane oxygenation (VA ECMO) is more acceptable to patients with refractory cardiogenic shock. The number of patients receiving VA ECMO treatment is increasing. However, mortality rate of patients cannulating VA ECMO is still high. Furthermore, VA ECMO treatment is expensive, requiring lots of resources and having lots of limitations. As a result, choosing patient wisely for cannulated VA ECMO is important. This is especially true for treatment in developing countries. Objective: To find the survival rate of patients receiving VA ECMO treatment and factors that affected survival rate. Materials and Methods: The present study was a retrospective study using the electronic medical database. Patients with cannulated VA ECMO between 2012 and 2019 were included in the study. Analyses were based on univariate and multivariate logistic regression to find factors associated with survival. Results: The authors found that out of 81 patients included in the present study, there were 20 survivors, representing a survival rate of 24.69%. Based on Univariate Analysis, factors measured at baseline that affected the survival rate were higher Glasgow Coma Scale, lower arterial blood gas carbon dioxide (ABG PaCO₂), lower blood level of lactate before cannulating VA ECMO, lower APACHE II, lower SOFA scores, and predicted mortality rate by SOFA score. Using multivariate regression, the ABG PaCO₂ and blood lactate level were significant factors that can predict survival rate (odd ratio 0.91, 95% CI 0.85 to 0.98 and 0.90, 95% CI 0.81 to 0.99, respectively). Conclusion: The present study found the survival rate of patients cannulating VA ECMO was 24.69%. The lower value of ABG PaCO₂ and lactate are significant factors that lead to higher survival rate. These findings lead to recommendations that, for an effective VA ECMO treatment, patients should not be at a severe sickness state, whose ABG PaCO₂ and lactate level should be at low levels. Keywords: Venoarterial extracorporeal membrane oxygenation (VA ECMO); Cardiogenic shock; In hospital survival rate; Factors affecting survival rate