Pulmonary Artery Pressures and Mortality during VA ECMO: An ELSO Registry Analysis

Abstract

Background: Systemic hemodynamics and specific ventilator settings have been shown to predict survival during venoarterial extracorporeal membrane oxygenation (VA ECMO). While these factors are intertwined with right ventricular (RV) function, the independent relationship between RV function and survival during VA ECMO is unknown. Objectives: To identify the relationship between RV function with mortality and duration of ECMO support. Methods: Cardiac ECMO runs in adults from the Extracorporeal Life Support Organization (ELSO) Registry between 2010 and 2022 were queried. RV function was quantified via pulmonary artery pulse pressure (PAPP) for pre-ECMO and on-ECMO periods. A multivariable model was adjusted for Society for Cardiovascular Angiography and Interventions (SCAI) stage, age, gender, and concurrent clinical data (i.e., pulmonary vasodilators and systemic pulse pressure). The primary outcome was in-hospital mortality. Results: A total of 4,442 ECMO runs met inclusion criteria and had documentation of hemodynamic and illness severity variables. The mortality rate was 55%; non-survivors were more likely to be older, have a worse SCAI stage, and have longer pre-ECMO endotracheal intubation times (P < 0.05 for all) than survivors. Improving PAPP from pre-ECMO to on-ECMO time (? PAPP) was associated with reduced mortality per 10 mm Hg increase (OR: 0.91 [95% CI: 0.86-0.96]; P=0.002). Increasing on-ECMO PAPP was associated with longer time on ECMO per 10 mm Hg (Beta: 15 [95% CI: 7.7-21]; P<0.001). Conclusions: Early improvements in RV function from pre-ECMO values were associated with mortality reduction during cardiac ECMO. Incorporation of ? PAPP into risk prediction models should be considered.

Neural Network-Driven Counter-Pulsation in Pulsatile Extracorporeal Membrane Oxygenator(ECMO): Enhancing Real-time Pulse Discrimination and Control Efficiency

“…According to data from the Extracorporeal Life Support Organization (ELSO), Patients undergoing VV-ECMO have a survival rate of 58%, whereas those undergoing VA-ECMO have a comparatively lower survival rate of 43% [4]. The existing ECMOs, which maintain a certain high blood pressure (BP) in the aorta, can lead to fatal side effects, such as left ventricular dilatation, increased left atrium pressure (LAP), and pulmonary edema when the patient's left ventricle (LV) contractility is weak and cannot generate a BP above the arterial pressure, thereby causing the blood in the LV to stagnate; consequently, this necessitates improvements to resolve blood stagnation in the LV [5][6][7][8].…”

Counter-pulsation Control of a Pulsatile Extracorporeal Membrane Oxygenator Device using Deep Neural Networks for Blood Pressure Waveform Analysis

“…According to data from the Extracorporeal Life Support Organization (ELSO), Patients undergoing VV-ECMO have been observed to have a survival rate of 58&, whereas those undergoing VA-ECMO have a comparatively lower survival rate of 43% [4]. The existing ECMO, which maintains a certain high blood pressure(BP) in the aorta, can lead to fatal side effects such as left ventricular dilatation, increased left atrium pressure (LAP), and pulmonary edema when the patient's left ventricle (LV) contractility is weak and cannot generate BP above arterial pressure, causing the blood in the LV to stagnate, thus necessitating improvements to resolve this issue of blood stagnation in the LV [5][6][7][8].…”