PhD Scientific Days 2021

Budapest, 7-8 July 2021

CL_I_P: Clinical Medicine I. Posters

Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population

Péter Kulyassa* MD, Balázs T. Németh* MD PhD, István Hartyánszky* MD PhD, Bálint Szilveszter* MD PhD, Levente Fazekas* MD PhD, Miklós Pólos* MD, Endre Németh† MD PhD, Dávid Becker* MD PhD, Béla Merkely* MD DSc, István F. Édes* MD PhD

*Semmelweis University, Heart and Vascular Center, Budapest, Hungary
†Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary

Text of the abstract

Introduction: Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in patients with critically decreased systolic function due to different clinical reasons. Few methods of MCS may be used, with the veno-arterial extracorporeal membrane oxygenation system (VA-ECMO) being one of the most utilized devices in everyday care.

Aim: Our aim was to determine independent predictors influencing mortality outcomes following VA-ECMO therapy in a large, unselected, critically ill, adult patient population in cardiogenic shock (CS).

Methods: Data on 235 consecutive, real-world VA-ECMO treatments have been analysed retrospectively. All included subjects were requiring MCS with the VA-ECMO as first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated with multivariate Cox regression analysis.

Results: Overall mortality amounted to ~66% at median 28 days follow-up and significantly depended upon pH<7.3 (HR 3.56; p<0.001), age ≥65 years (HR: 1.96; p=0.001). Acute coronary syndrome (ACS) as indication for VA-ECMO displayed an inferior result with nearly significant value (HR: 1.44; p=0.07) while in the case of heart transplant (hTX) primary graft failure it presented a clearly favourable outcome (HR: 0.51, p=0.025).

Conclusions: Mortality in patients requiring VA-ECMO therapy remains high. In our study the clearly influencing factors were decreased pH values and advanced age in this MCS scenario. ACS patients had rather unfavourable outcome, yet hTX as an indication showed better survival.

Funding: There was no external funding received for this study.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine