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Prognostic Factors for Survival After Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Huang, Mingjie; Ong, Boon Hean; Hoo, Anne Ean Ean; Gao, Fei; Chao, Victor Tar Toong; Lim, Chong Hee; Tan, Teing Ee; Sin, Kenny Yoong Kong

doi: 10.1097/MAT.0000000000000984
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The aim of this study is to examine factors that can predict mortality in patients that have veno-arterial extracorporeal membrane oxygenation (VA-ECMO) instituted for cardiogenic shock. A single-center, retrospective study of 127 patients who underwent VA-ECMO for cardiogenic shock between January 2003 and December 2017 was conducted. Eighty-three (65%) patients survived to weaning or bridging therapy. Complications on VA-ECMO include: hemorrhage (40%), stroke (14%), requirement for dialysis (42%), and limb ischemia (24%). Univariate analysis revealed shorter ECMO duration, higher body mass index, preimplantation creatinine > 100 mmol/l, lower preimplantation serum albumin, and the development of stroke or limb ischemia on ECMO to be significantly associated with mortality while on ECMO. Multivariate analysis by logistic regression found shorter ECMO duration and lower preimplantation serum albumin to be significantly associated with mortality. VA-ECMO is an effective strategy in treating patients with cardiogenic shock and provides a reasonable chance of survival to weaning or bridging to other therapy. Preimplantation hypoalbuminemia, preimplantation serum creatinine > 100 mmol/l, and the development of stroke and limb ischemia while on VA-ECMO are strongly associated with mortality.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.

Submitted for consideration September 2018; accepted for publication in revised form February 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Dr Huang Mingjie, Block 137 Bedok Reservoir Road #10–1453 S470137, Singapore. Email: mingjie.huang@mohh.com.sg.

Copyright © 2019 by the American Society for Artificial Internal Organs