Incidence and Prognosis of Post-Cannulation Complications in Postcardiotomy Shock Patients Requiring Venoarterial ECMO
Eric W. Etchill, Katherine Giuliano, Chun Woo (Dan) Choi, Sung-Min Cho, Glenn JR Whitman
Johns Hopkins Hospital, Baltimore, MD, USA
OBJECTIVE: While pre-ECMO-cannulation prognostic factors are known, little is known about how complications acquired after cannulation affect VA-ECMO outcomes, and how these complications differentially affect patients in postcardiotomy cardiogenic shock (PCS). We investigated how post-cannulation complications affect PCS ECMO patients and compared them to non-PCS ECMO patients. METHODS: We conducted an institutional mixed retrospective/prospective analysis of adults requiring VA-ECMO between 2016-2019. After controlling for demographics and pre-ECMO variables (e.g. hemodynamics, lactate), we studied the impact of thrombotic (e.g. limb ischemia, stroke), mechanical (e.g. circuit clot), hemorrhagic (e.g. bleeding requiring transfusion), infectious, and renal complications on survival and secondary outcomes using multivariable regression.RESULTS: 120 patients were included, 51 (42%) in the PCS and 69 (58%) in the non-PCS group. PCS patients were older and more likely to have hypertension. PCS patients had higher in-hospital mortality (82% vs. 62%, p=0.02) and were more likely to develop bacteremia (33% vs 13%, p=0.01), limb ischemia (25% vs. 9%, p=0.012), thrombotic (57% vs. 34%, p=0.013), and hemorrhagic (75% vs. 57%, p=0.049) complications. ECMO duration was not different between the two groups. No pre-ECMO characteristics or ECMO complications were associated with mortality among PCS patients. Age (OR 1.07, 95% CI 1.03-1.11) and renal replacement therapy (OR 8.2, 95% CI 2.2-30.5) were associated with mortality in non-PCS patients.CONCLUSIONS: Patients placed on VA-ECMO for PCS have higher in-hospital mortality and higher rates of post-cannulation complications compared to non-PCS VA-ECMO patients. Development of complications while on ECMO, however, did not independently increase the risk of mortality in PCS.
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