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Predictors of Survival for Patients with Acute Decompensated Heart Failure Requiring Extra-Corporeal Membrane Oxygenation Therapy

Garan, A. Reshad*; Malick, Waqas A.*; Habal, Marlena*; Topkara, Veli K.*; Fried, Justin*; Masoumi, Amirali*; Hasan, Aws K.*; Karmpaliotis, Dimitri*; Kirtane, Ajay*; Yuzefpolskaya, Melana*; Farr, Maryjane*; Naka, Yoshifumi; Burkhoff, Dan*; Colombo, Paolo C.*; Kurlansky, Paul; Takayama, Hiroo; Takeda, Koji

doi: 10.1097/MAT.0000000000000898
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Chronic systolic heart failure (HF) with acute decompensation can result in cardiogenic shock (CS) requiring short-term mechanical circulatory support. We sought to identify predictors of survival for acute decompensated HF (ADHF) patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients >18 years old treated at our institution with VA-ECMO from 2009 to 2018 for ADHF with CS were studied. Demographic, hemodynamic, and echocardiographic data were collected. The primary outcome was survival to discharge. Fifty-two patients received VA-ECMO for ADHF with CS; 24 (46.2%) survived. Seventeen (32.7%) had suffered cardiac arrest, and 37 (71.2%) were mechanically ventilated. Mean lactate was 4.33 ± 3.45 mmol/L, and patients were receiving 2.7 ± 1.2 vasopressor/inotropic infusions at ECMO initiation; these did not differ significantly between survivors and nonsurvivors. Pre-ECMO cardiac index was 1.84 ± 0.56L/min/m2 and 1.94 ± 0.63L/min/m2 in survivors and nonsurvivors, respectively (p = 0.57). In multivariable analysis, only diabetes mellitus (DM; OR, 13.25; CI, 1.42–123.40; p = 0.02) and mineralocorticoid receptor antagonist use (OR, 0.12; CI, 0.02–0.78; p = 0.03) were independent predictors of mortality. Nineteen (79.2%) survivors required durable ventricular assist device. Among ADHF patients receiving VA-ECMO, DM is a powerful predictor of outcomes while markers of clinical acuity including hemodynamics, vasopressor/inotrope use, and lactate are not. The vast majority of survivors required durable left-ventricular assist devices.

From the *Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York

Department of Surgery, Columbia University Medical Center, New York, New York.

Submitted for consideration June 2018; accepted for publication in revised form September 2018.

Disclosure: Dr. Garan is supported by National Institutes of Health Grant No. KL2TR001874, has previously received honoraria from Abiomed (Danvers, MA), and is now an unpaid consultant for Abiomed. Dr. Naka has received consulting fees from St. Jude Medical/Abbott Vascular (St. Paul, MN).

Correspondence: Arthur Reshad Garan, 177 Fort Washington Avenue, Room 5-435A, New York, NY 10033. Email: arg2024@cumc.columbia.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs