Impact of age on outcomes of patients assisted by veno-arterial or veno-venous extra-corporeal membrane oxygenation: 403 patients between 2005 and 2015

Abstract

Introduction: To assess the impact of age on early outcomes and mortality in veno-arterial extra-corporeal membrane oxygenation and veno-venous extra-corporeal membrane oxygenation recipients, and to investigate predictors of mortality. Methods: Single-center retrospective study on prospectively collected data including all patients treated by veno-venous extra-corporeal membrane oxygenation and veno-arterial extra-corporeal membrane oxygenation (January 2005-July 2015). Outcomes were compared among two subgroups: aged less than 65 years (Group 1) versus more than 65 years (Group 2) and by type of support (veno-arterial extra-corporeal membrane oxygenation or veno-venous extra-corporeal membrane oxygenation). Results: Among 403 patients, 20.3% were treated by veno-venous extra-corporeal membrane oxygenation and 79.7% by veno-arterial extra-corporeal membrane oxygenation. Veno-arterial extra-corporeal membrane oxygenation group: 76.6% were included in Group 1 and were more severe (pH 7.30 ± 0.19 vs. 7.35 ± 0.13 in Group 2, p = 0.003; lactates 7.5 ± 5.6 mmol/L vs. 5.8 ± 4.5 mmol/L in Group 2, p = 0.003). Weaning rate was higher in Group 1 (63.8% vs. 45.3%, p = 0.0043). The 30-day survival was higher in Group 1 (52.0% vs. 25.3%, p < 0.001). Univariate analysis identified higher Simplified Acute Physiology Score II (p = 0.02) and noradrenaline (p = 0.04) to be associated with mortality. Veno-venous extra-corporeal membrane oxygenation group: 80.5% were in Group 1. Mean PaO2 was 73.5 ± 42.9 mm Hg versus 100.8 ± 80.3 mm Hg (p = 0.24); FiO2 90.1% ± 18% versus 89.4% ± 16.4% (p = 0.89); and 30-day survival 56.1% versus 25.0% (p = 0.048). Conclusion: Patients older than 65 years have higher mortality after veno-arterial extra-corporeal membrane oxygenation or veno-venous extra-corporeal membrane oxygenation. This therapeutic strategy is feasible in the elderly, but comorbidities and clinical presentation have a major impact on prognosis and need to be seriously considered to avoid futile treatment.

Candidates and allocation time for extracorporeal membrane oxygenation in patients with cardiogenic shock

“…As observed in other diseases, older patients receiving ECMO have a poorer prognosis than younger patients, without evidence of age threshold effect [51–53] . However, the impact of age on short-term and long-term prognosis in patients undergoing ECMO may not be independent but rather confounded by comorbidities, clinical presentation, and additional unidentified factors [54–57] .…”

“…As observed in other diseases, older patients receiving ECMO have a poorer prognosis than younger patients, without evidence of age threshold effect. [51][52][53] However, the impact of age on short-term and long-term prognosis in patients undergoing ECMO may not be independent but rather confounded by comorbidities, clinical presentation, and additional unidentified factors. [54][55][56][57] Accumulated evidence suggests that biological age itself is less useful for guiding the patient selection for urgent ECMO use in the situation of cardiogenic shock.…”

Extracorporeal membrane oxygenation for COVID‐19‐associated acute respiratory distress syndrome: A nationwide analysis

“…Extremely old patients are generally not regarded as eligible for such invasive procedures. 12,13 The no-ECMO group also had higher proportions of dementia and cancer, which might have been considered "terminal" at the responsible physician's discretion. However, all these factors were T A B L E 4 In-hospital complications and outcomes of COVID-19-associated ARDS according to the use of extracorporeal membrane oxygenation.…”

“…First, the no‐ECMO group had the highest mean age, potentially implying that ECMO was more likely to be initiated in patients who were perceived viable. Extremely old patients are generally not regarded as eligible for such invasive procedures 12,13 . The no‐ECMO group also had higher proportions of dementia and cancer, which might have been considered “terminal” at the responsible physician's discretion.…”

Platelet Phenotype and Function Changes With Increasing Duration of Extracorporeal Membrane Oxygenation

“…Age is associated with increased mortality risk in both adult and pediatric ECMO patients (36)(37)(38)(39). Dalton et al (3) reported that age did not impact survival in pediatric ECMO, yet age was associated with bleeding and thrombosis.…”