Complications of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock or cardiac arrest

• Published in: International journal of artificial organs 2020-01, Vol.43 (1), p.37-44
• Main Authors: Lee, Soo Youn, Jeon, Ki-Hyun, Lee, Hyun Jong, Kim, Ji-Bak, Jang, Ho-Jun, Kim, Je Sang, Kim, Tae Hoon, Park, Jin-Sik, Choi, Rak Kyeong, Choi, Young Jin
• Format: Article
• Language: English
• Subjects: Aged; Bleeding; Cerebral infarction; Complications; Confidence intervals; Extracorporeal Membrane Oxygenation - adverse effects; Female; Heart; Heart Arrest - mortality; Heart Arrest - therapy; Hemorrhage - epidemiology; Hernias; Humans; Infections - epidemiology; Male; Medical prognosis; Membranes; Morbidity; Mortality; Myocardial infarction; Oxygenation; Renal Dialysis - statistics & numerical data; Renal replacement therapy; Respiratory therapy; Risk analysis; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Stroke - epidemiology; Survival; Therapy
• ISSN: 0391-3988; 1724-6040
• DOI: 10.1177/0391398819868483

Background: The frequency of using veno-arterial extracorporeal membrane oxygenation increased, especially in patients with refractory cardiogenic shock or cardiac arrest. However, data of complications of veno-arterial extracorporeal membrane oxygenation are lacking. This study sought to investigate the incidence of veno-arterial extracorporeal membrane oxygenation complications for acute myocardial infarction patients with refractory cardiogenic shock or cardiac arrest and its relationship with patient survival. Methods: This study included 151 consecutive patients who underwent veno-arterial extracorporeal membrane oxygenation between 2006 and 2018 at a single referral center. We divided the patients into those who survived for 30 days after veno-arterial extracorporeal membrane oxygenation (n = 57, 38%; group 1) and those who died within 30 days after veno-arterial extracorporeal membrane oxygenation support (n = 94, 62%; group 2). The major adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation were defined as first occurrence of infection, major bleeding, and stroke. Results: Adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation occurred in 34 (59.6%) and 56 (59.6%) patients in groups 1 and 2, respectively. Group 2 had more patients who underwent new renal replacement therapy (21.1% vs 37.2%, p = 0.037). After multivariable analysis, cardiac arrest was independently associated with 30-day mortality (odds ratio = 3.6; 95% confidence interval = 1.7–7.63; p = 0.001). After excluding patients who died within 48 h after undergoing veno-arterial extracorporeal membrane oxygenation, new renal replacement therapy (odds ratio = 4.47; 95% confidence interval = 1.58–12.61; p = 0.005) and major adverse clinical events (odds ratio = 2.66; 95% confidence interval = 1.01–7.03; p = 0.049) were independently associated with 30-day mortality. Conclusion: Although veno-arterial extracorporeal membrane oxygenation can improve the survival, it is associated with morbidity. Therefore, risk–benefit analysis for veno-arterial extracorporeal membrane oxygenation and prevention of complications are important to improve prognosis.