ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a specialised life support modality for patients with refractory cardiac or respiratory failure. Multiple studies strived to evaluate the benefits of ECMO support, but its efficacy remains controversial with still inconsistent and sparse information. Methods: This retrospective analysis included patients with ECMO support, admitted between January 2010 and December 2019 at a tertiary university ECMO referral centre in Austria. The primary endpoint of the study was overall all-cause three-month mortality with risk factors and predictors of mortality. Secondary endpoints covered the analysis of demographic and clinical characteristics of patients needing ECMO, including incidence and type of adverse events during support. Results: In total, 358 patients fulfilled inclusion criteria and received ECMO support due to cardiogenic shock (258, 72%), respiratory failure (88, 25%) or hypothermia (12, 3%). In total, 41% (145) of patients died within the first three months, with the median time to death of 9 (1–87) days. The multivariate analysis identified hypothermia (HR 3.8, p < 0.001), the Simplified Acute Physiology Score III (HR 1.0, p < 0.001), ECMO initiation on weekends (HR 1.6, p = 0.016) and haemorrhage during ECMO support (HR 1.7, p = 0.001) as factors with higher risk for mortality. Finally, the most frequent adverse event was haemorrhage (160, 45%) followed by thrombosis. Conclusions: ECMO is an invasive advanced support system with a high risk of complications. Nevertheless, well-selected patients can be successfully rescued from life-threatening conditions by prolonging the therapeutic window to either solve the underlying problem or install a long-term assist device. Hypothermia, disease severity, initiation on weekends and haemorrhage during ECMO support increase the risk for mortality. In the case of decision making in a setting of limited (ICU) resources, the reported risk factors for mortality may be contemplable, especially when judging a possible ECMO support termination.

Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications

“…In the case of a COVID-19-related ECMO indication, ELSO defined an age of more than 65 years as a relative and an even higher age as an absolute contraindication for ECMO initiation [ 43 ]. A recent retrospective study pointed out the importance of a patient-oriented and individualized approach in decision-making related to ECMO support initiation, arguing against the use of any age-related cutoffs [ 44 ]. In our work, an age of more than 60 years (median age of reported population), was associated with increased mortality (Additional file 1 : Figure S2).…”

Lung Sonography in Critical Care Medicine

“…Furthermore, point-of-care lung sonography helps monitor an early fluid loading in ARDS [ 13 ] and antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia [ 68 ]. In ARDS patients supported with an extracorporeal membrane oxygenation (ECMO), lung sonography allows for the monitoring of the disease course and may indicate eventual lung recovery, with the potential of early ECMO weaning initiation and a consequent improved patient outcome [ 69 , 70 ].…”

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

“…Despite immense research and development in the field of ECMO circuit technology in the last decades, a need for systemic anticoagulation therapy still exists. The potential improvement of the clinical outcomes of patients undergoing ECMO support depends on the underlying disease and comorbidities, the technology employed, and on anticoagulation [ 16 ].…”

“…Moreover, clinical studies should further narrow down the reported range of thrombosis incidence, which is perceived as one of the most important indications for anticoagulation. This holds especially true as bleeding increases mortality, but thrombosis does not [ 16 ].…”

“…It achieves anticoagulatory effects by enhancing the activity of antithrombin, which results in downregulation of thrombin and activated factor X (factor Xa) [ 14 ]. However, therapeutic anticoagulation of a critically ill patient carries the risk of clinically relevant bleeding with the potential for permanent injury or death [ 15 , 16 , 17 ]. Similarly, thrombotic events may occur [ 18 , 19 ].…”