ECTSS - Outcomes of End-organ Function and Survival With Veno-arterial Extracorporeal Membrane Oxygenation

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Outcomes of End-organ Function and Survival With Veno-arterial Extracorporeal Membrane Oxygenation
Toru Mihama, Nataliya Bahatyrevich, Nicholas Cavarocchi, Hitoshi Hirose
Thomas Jefferson University, Philadelphia, PA, USA

Objective: Extracorporeal Membrane Oxygenation (ECMO) is a temporary therapy option for refractory cardiac or respiratory failure. This study investigates the impact of end-organ function by maintaining perfusion with ECMO. Methods: A retrospective IRB approved database research and chart review was performed on patients initiated on veno-arterial (VA-) ECMO between September 2010 and April 2019. End-organ markers were compared between the pre-ECMO period, defined as period before ECMO initiation, and the pre-decannulation period, defined as period prior to ECMO decannulation. Data was expressed with mean ± standard deviation, or median [quartile 1, quartile 3]. Results: Among the 159 VA-ECMO patients, 100 patients (63%) survived ECMO. Within the survival group, 78 patients (49%) weaned to recovery, and 22 patients (14%) weaned off to durable implantable devices. Longitudinal changes in end-organ marker are summarized in Table 1. Compared to pre-ECMO, pre-decannulation period significantly improved in pH (7.23 ± 0.19 vs. 7.40 ± 0.09; p<0.001) and lactate (5.5 [2.3, 9.0] vs. 1.6 [0.9, 2.3]; p<0.001), and serum creatinine (1.4 [1.1, 2.1] vs. 1,1 [0.8, 1.7]; p<0.001). Significant changes were noted in ventilation parameters as well, such as FiO2 (100 [100, 100] vs. 50 [50, 50]; p<0.001), PaO₂ (88 [62,135], 126 [87,162]; p<0.001) and PEEP (8.0 [5.0, 12.0] vs. 5.0 [5.0, 8.0]; p<0.001). Conclusions: Maintaining perfusion with VA-ECMO utilization on indicated patients demonstrated improvements in end-organ functions. Survival rates of VA-ECMO patients were also optimistic.

Table 1: Pre-ECMO and pre-decannulation end organ function
Lab Work Pre-ECMO Pre-decannulation p-value
pH 7.23 ± 0.19 7.40 ± 0.09 <0.001
Lactate (mg/dL) 5.5 [2.3, 9.0] 1.6 [0.9, 2.3] <0.001
AST (IU/L) 85 [32, 416] 73 [44, 168] 0.818
ALT (IU/L) 78 [27, 229] 59 [28, 102] 0.107
Creatinine (mg/dL) 1.4 [1.1, 2.1] 1.1 [0.8, 1.7] <0.001
Ventilation Settings
FiO₂ (%) of ventilator 100 [100, 100] 50 [50, 50] <0.001
PEEP (cmH₂O) 8.0 [5.0, 12.0] 5.0 [5.0, 8.0] <0.001
PaO₂ (mmHg) 88 [62, 135] 126 [87, 162] <0.001

Table 1: Pre-ECMO and pre-decannulation end organ function
Lab Work	Pre-ECMO	Pre-decannulation	p-value
pH	7.23 ± 0.19	7.40 ± 0.09	<0.001
Lactate (mg/dL)	5.5 [2.3, 9.0]	1.6 [0.9, 2.3]	<0.001
AST (IU/L)	85 [32, 416]	73 [44, 168]	0.818
ALT (IU/L)	78 [27, 229]	59 [28, 102]	0.107
Creatinine (mg/dL)	1.4 [1.1, 2.1]	1.1 [0.8, 1.7]	<0.001
Ventilation Settings
FiO₂ (%) of ventilator	100 [100, 100]	50 [50, 50]	<0.001
PEEP (cmH₂O)	8.0 [5.0, 12.0]	5.0 [5.0, 8.0]	<0.001
PaO₂ (mmHg)	88 [62, 135]	126 [87, 162]	<0.001

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