Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated With Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center

Mudit Kaushal, Joseph Schwartz, Nitish Gupta, Jay Im, Jonathan D. Leff, William A. Jakobleff, Galina Leyvi

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1 Citation (Scopus)

Abstract

Objective: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. Design: Retrospective observational study. Setting: Urban university hospital, quaternary care center. Participants: Patients who underwent ECMO circulatory support from January 2012 to May 2016. Interventions: Date-based data extraction, univariate and multivariate regression analysis. Measurements and Main Results: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 %) and venovenous ECMO (25.96 %); 106 patients (45.11%) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). Conclusion: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors’ knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

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Odds Ratio
Demography
Survival
Cardiopulmonary Resuscitation
Cardiogenic Shock
Ischemia
Extremities
Acute Kidney Injury
Mortality
Urban Hospitals
Hospital Mortality
Observational Studies
Multivariate Analysis
Retrospective Studies
Regression Analysis
Databases

Keywords

  • ECMO
  • femoral cannulation complications
  • limb ischemia
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

@article{288ab573f7c349a899392392473466b0,
title = "Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated With Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center",
abstract = "Objective: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. Design: Retrospective observational study. Setting: Urban university hospital, quaternary care center. Participants: Patients who underwent ECMO circulatory support from January 2012 to May 2016. Interventions: Date-based data extraction, univariate and multivariate regression analysis. Measurements and Main Results: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 {\%}) and venovenous ECMO (25.96 {\%}); 106 patients (45.11{\%}) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). Conclusion: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors’ knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.",
keywords = "ECMO, femoral cannulation complications, limb ischemia, survival",
author = "Mudit Kaushal and Joseph Schwartz and Nitish Gupta and Jay Im and Leff, {Jonathan D.} and Jakobleff, {William A.} and Galina Leyvi",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.jvca.2018.08.193",
language = "English (US)",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated With Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center

AU - Kaushal, Mudit

AU - Schwartz, Joseph

AU - Gupta, Nitish

AU - Im, Jay

AU - Leff, Jonathan D.

AU - Jakobleff, William A.

AU - Leyvi, Galina

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. Design: Retrospective observational study. Setting: Urban university hospital, quaternary care center. Participants: Patients who underwent ECMO circulatory support from January 2012 to May 2016. Interventions: Date-based data extraction, univariate and multivariate regression analysis. Measurements and Main Results: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 %) and venovenous ECMO (25.96 %); 106 patients (45.11%) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). Conclusion: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors’ knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.

AB - Objective: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. Design: Retrospective observational study. Setting: Urban university hospital, quaternary care center. Participants: Patients who underwent ECMO circulatory support from January 2012 to May 2016. Interventions: Date-based data extraction, univariate and multivariate regression analysis. Measurements and Main Results: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 %) and venovenous ECMO (25.96 %); 106 patients (45.11%) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). Conclusion: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors’ knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.

KW - ECMO

KW - femoral cannulation complications

KW - limb ischemia

KW - survival

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U2 - 10.1053/j.jvca.2018.08.193

DO - 10.1053/j.jvca.2018.08.193

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