Clinical predictors of in-hospital mortality in venoarterial extracorporeal membrane oxygenation

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is utilized as a life-saving procedure and bridge to myocardial recovery for patients in refractory cardiogenic shock. Despite technical advancements, VA-ECMO retains high mortality. This study aims to identify the clinical predictors of in-hospital mortality after VA-ECMO to improve risk stratification for this tenuous patient population. Methods: The REgistry for Cardiogenic Shock: Utility and Efficacy of Device Therapy database is a multicenter, observational registry of ECMO patients. From 2013 to 2018, 789 patients underwent VA-ECMO. Bivariate analysis was performed on more than 300 variables regarding their association with in-hospital mortality. Logistic regression analyses were performed with variables chosen based upon clinical and statistical significance in the bivariate analysis. Tests were considered significant at a two-sided P <.05. Results: Although 63.5% patients were successfully weaned from VA-ECMO, in-hospital mortality was 57.9%. Nonsurvivors were older (P <.0001), had higher body mass index (P =.01), higher rates of hypertension (P =.02), coronary artery disease (P =.02), chronic obstructive pulmonary disease (P =.02), chronic liver disease (P =.008), percutaneous coronary intervention (P =.02), and surgical revascularization (P =.02). Multivariate predictors for in-hospital mortality include older age (odds ratio [OR], 1.019; P =.007), cardiac arrest (OR, 2.76; P =.006), chronic liver disease (OR, 8.87; P =.04), elevated total bilirubin (OR, 1.093; P <.0001), and the presence of a left ventricular vent (OR, 2.018; P =.03). Pre-ECMO sinus rhythm was protective (OR, 0.374; P =.006). Conclusions: In a large study of recent VA-ECMO patients, in-hospital mortality remains significant, but acceptable given the severe pathology manifested in this population. Identification of pre-ECMO predictors of mortality helps stratify high-risk patients when deciding on ECMO placement, prolonged support, and prognosis.