Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO)

8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center

Ivo M.B. Francischetti, James Szymanski, Daniel Rodriguez, Moonseong Heo, Lucia R. Wolgast

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Materials and methods Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007–2014). Results Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30 days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (< 10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45 yo vs 55 yo, p = 0.0001) and higher systolic blood pressure (115 mm Hg vs 103 mm Hg, p = 0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p = 0.0003), chloride (p = 0.009), bicarbonate (p = 0.015) and pH (p = 0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02–1.13; p = 0.004), pH (OR 3.35; 95% CI 1.89–5.9; p < 0.0001) and aPTT (OR 0.98; 95% CI 0.976–0.998; p = 0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06–3.34; p = 0.029). Conclusions Laboratory markers identified herein may guide the management of patients on ECMO.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalJournal of Critical Care
Volume40
DOIs
StatePublished - Aug 1 2017

Fingerprint

Extracorporeal Membrane Oxygenation
Medicine
Survival
Blood Pressure
Catheterization
Survivors
Chlorides
Preexisting Condition Coverage
Electronic Health Records
Lymphocyte Count
Hemostatics
Bicarbonates
Platelet Count
Population
Glass
Communicable Diseases
Creatinine
Patient Care
Software
Multivariate Analysis

Keywords

  • ECMO
  • Epidemiology
  • Retrospective study
  • Risk factors
  • Venous, arterial

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{e326c3f9c377424baf5b2c8e3936d6ff,
title = "Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center",
abstract = "Purpose Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Materials and methods Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007–2014). Results Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30 days. Indications for ECMO were cardiac (65{\%}), respiratory (25{\%}) and infectious diseases (< 10{\%}). Eighty six patients (51.8{\%}) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45 yo vs 55 yo, p = 0.0001) and higher systolic blood pressure (115 mm Hg vs 103 mm Hg, p = 0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p = 0.0003), chloride (p = 0.009), bicarbonate (p = 0.015) and pH (p = 0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95{\%} CI 1.02–1.13; p = 0.004), pH (OR 3.35; 95{\%} CI 1.89–5.9; p < 0.0001) and aPTT (OR 0.98; 95{\%} CI 0.976–0.998; p = 0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95{\%} CI 1.06–3.34; p = 0.029). Conclusions Laboratory markers identified herein may guide the management of patients on ECMO.",
keywords = "ECMO, Epidemiology, Retrospective study, Risk factors, Venous, arterial",
author = "Francischetti, {Ivo M.B.} and James Szymanski and Daniel Rodriguez and Moonseong Heo and Wolgast, {Lucia R.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.jcrc.2017.03.027",
language = "English (US)",
volume = "40",
pages = "136--144",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO)

T2 - 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center

AU - Francischetti, Ivo M.B.

AU - Szymanski, James

AU - Rodriguez, Daniel

AU - Heo, Moonseong

AU - Wolgast, Lucia R.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Materials and methods Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007–2014). Results Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30 days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (< 10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45 yo vs 55 yo, p = 0.0001) and higher systolic blood pressure (115 mm Hg vs 103 mm Hg, p = 0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p = 0.0003), chloride (p = 0.009), bicarbonate (p = 0.015) and pH (p = 0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02–1.13; p = 0.004), pH (OR 3.35; 95% CI 1.89–5.9; p < 0.0001) and aPTT (OR 0.98; 95% CI 0.976–0.998; p = 0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06–3.34; p = 0.029). Conclusions Laboratory markers identified herein may guide the management of patients on ECMO.

AB - Purpose Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Materials and methods Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007–2014). Results Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30 days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (< 10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45 yo vs 55 yo, p = 0.0001) and higher systolic blood pressure (115 mm Hg vs 103 mm Hg, p = 0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p = 0.0003), chloride (p = 0.009), bicarbonate (p = 0.015) and pH (p = 0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02–1.13; p = 0.004), pH (OR 3.35; 95% CI 1.89–5.9; p < 0.0001) and aPTT (OR 0.98; 95% CI 0.976–0.998; p = 0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06–3.34; p = 0.029). Conclusions Laboratory markers identified herein may guide the management of patients on ECMO.

KW - ECMO

KW - Epidemiology

KW - Retrospective study

KW - Risk factors

KW - Venous, arterial

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U2 - 10.1016/j.jcrc.2017.03.027

DO - 10.1016/j.jcrc.2017.03.027

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VL - 40

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EP - 144

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

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