Short-term outcomes and predictors of in-hospital mortality with the use of veno-arterial extracorporeal membrane oxygenation in elderly patients with refractory cardiogenic shock

Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry*

“…Peripheral cannulation was used more frequently than central cannulation in the study group. This is in accordance with the findings of Sertic et al (19) who showed that central cannulation is associated with worse outcomes in older patients but may be related to poor clinical condition of the postcardiotomy patients, however. The use of VA ECMO for postcardiotomy support has been recently associated with poor results most likely because of pre-ECMO comorbidities, the impact of preoperative cardiac illnesses and complicated surgical procedures, and complications inherent to these procedures, such as bleeding (6).…”

“…Complications rates remain high during VA ECMO support (24)(25)(26), and our study confirmed the high frequency of major complications in elderly patients supported with VA ECMO. We confirmed that cardiovascular and end-organ perfusion adverse events are the most frequent complications, followed by bleeding and renal complications, as shown by other investigators (18,19). These dreadful complications may result in a shorter duration of ECMO support, which may impede acceptable cardiocirculatory support or indicate an extremely low chance of recovery, prompting the attending personnel to early interruption of ongoing mechanical assistance (19).…”

“…Elderly patients have a somehow peculiar profile with respect to their indications for ECMO support. Indeed, the most frequent indication for ECMO use in the current series was nonpostcardiotomy cardiogenic shock, which differs from the most frequent indication in previous series of elderly patients (18,19,23). Although postcardiotomy patients older than 70 years old are healthier at baseline than the general elderly population due to the fact that they were cleared to undergo major surgery, surprisingly, postoperative indications for VA ECMO placement are less common in older patients as compared to their younger counterparts (7).…”

“…The use of VA ECMO for support of RCS of other etiologies may yield better results. Sertic et al (19) demonstrated that postacute myocardial infarction ECMO placement had better outcomes, which was confirmed in a postdischarge assessment. In fact, patients with an acute myocardial infarction often have undergone an escalation in support with an intra-aortic balloon pump or Impella pump (Abiomed, Inc. Danvers, MA) placed before escalation to ECMO, which is different from ECMO use in the postcardiotomy setting.…”

“…The search for predictors of mortality and complications is critical to improve results, resource utilization, and decision-making when treating patients with challenging conditions (17). Among several well-known factors, age has been identified as associated with less satisfactory in-hospital outcomes (Supplemental Table 3, Supplemental Digital Content 1, http:// links.lww.com/CCM/F924) (7,11,12,14,(16)(17)(18)(19)(20)(21)(22). Indeed, our recent ELSO registry analysis comparing younger (< 70 yr of age) versus older (≥ 70 yr of age) patients confirmed that elderly patients are more likely to experience complications and in-hospital mortality.…”