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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 WorkPre-ECMOPre-decannulationp-value
pH7.23 ± 0.197.40 ± 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 ventilator100 [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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