Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: single-center experience with 679 patients

Abstract

Background: Extracorporeal life support (ECLS) therapy is increasingly used for cardiac and respiratory support postcardiotomy, refractory cardiogenic shock and cardiopulmonary resuscitation. This study aims to describe in-hospital mortality of patients requiring ECLS, identify independent predictors associated with mortality and analyze changes of mortality over time.Methods: This retrospective study includes all adult ECLS cases at the University Hospital Zurich, a designated ECLS center in Switzerland, in the period 2007 to 2019.Results: ECLS therapy was required in 679 patients (median age 60 years, 27.5% female). In-hospital mortality was 55.5%. Cubic spline interpolation did not detect evidence for a change in mortality over the whole period of 13 years. In-hospital mortality significantly varied between ECLS indications: 70.7% (152/215) for postcardiotomy, 67.9% (108/159) for cardiopulmonary resuscitation, 47.0% (110/234) for refractory cardiogenic shock, and 9.9% (7/71) for lung transplantation and expansive thoracic surgery (P<0.001). Logistic regression modelling showed excellent discrimination in the receiver operating characteristic (ROC) area under the curve (AUC) of 0.89 [95% confidence interval (CI): 0.87-0.92] and identified significant mortality predictors: age, simplified acute physiology score (SAPS) II, as well as new liver failure and each allogenic blood transfusion unit given per day. ECLS after cardiopulmonary resuscitation was associated with significantly higher mortality compared to ECLS for refractory cardiogenic shock. Conclusions:In-hospital mortality of patients treated with ECLS therapy is high. Outcomes have not changed significantly in the observed period. We identified age, SAPS II, new liver failure and each allogenic blood transfusion unit given per day as independent mortality predictors. Knowledge of predictors strongly associated with in-hospital mortality may affect future decisions about ECLS indications and the respective management to use this elaborate therapy more effectively.

Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

“…A total of 273 articles were yielded from a systematic review of the literature and 31 studies were considered suitable for the present analysis. The investigators of 10 studies 2,[8][9][10][11][12][13][14][15][16] provided data for the present analysis. The types and quality of the included studies are summarized in Table 2.…”

Is Fasciotomy Associated With Increased Mortality in Extracorporeal Cardiopulmonary Resuscitation?

“…All mortality models included carbon dioxide, lactate, and BP, as these have been previously identified as risk factors for mortality for patients on VA-ECMO. [23][24][25][26] Additionally, BP is a parameter in the Simplified Acute Physiology Score II, which has been demonstrated to be an independent predictor of mortality on VA-ECMO. 24,26,27 To minimize collinearity between clinically similar variables, such as partial pressure of oxygen (PO 2 ), arterial blood saturation of oxygen (SaO 2 ), and pulse oximetry saturation of oxygen (SpO 2 ), the variable with the least amount of missing data was used.…”

“…[23][24][25][26] Additionally, BP is a parameter in the Simplified Acute Physiology Score II, which has been demonstrated to be an independent predictor of mortality on VA-ECMO. 24,26,27 To minimize collinearity between clinically similar variables, such as partial pressure of oxygen (PO 2 ), arterial blood saturation of oxygen (SaO 2 ), and pulse oximetry saturation of oxygen (SpO 2 ), the variable with the least amount of missing data was used. Because pH and PO 2 were collinear with lactate on analysis, they were excluded from logistic regression.…”

ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality

“…Our multivariable model identified hemorrhage (HR 1.73, p = 0.005) during ECMO support as an independent risk factor for death, which is well-established in current literature [ 8 , 9 ]. Furthermore, this potentially lethal complication is independent of the type of ECMO configuration [ 4 , 6 , 21 ].…”

“…Multiple studies tried to identify predictors and risk factors for adverse events and mortality during ECMO support; however, inconsistent results indicate a need for further research [ 2 , 3 , 4 , 5 , 6 , 7 ]. It is well-established that hemorrhage has a strong impact on mortality [ 8 , 9 ], but studies failed to identify unique risk factors for bleeding [ 10 , 11 , 12 , 13 , 14 , 15 ].…”