Predictors of Survival for Patients with Acute Decompensated Heart Failure Requiring Extra-Corporeal Membrane Oxygenation Therapy

A. Reshad Garan, Waqas A. Malick, Marlena Habal, Veli K. Topkara, Justin Fried, Amirali Masoumi, Aws K. Hasan, Dimitri Karmpaliotis, Ajay Kirtane, Melana Yuzefpolskaya, Maryjane Farr, Yoshifumi Naka, Dan Burkhoff, Paolo C. Colombo, Paul Kurlansky, Hiroo Takayama, Koji Takeda

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Chronic systolic heart failure (HF) with acute decompensation can result in cardiogenic shock (CS) requiring short-term mechanical circulatory support. We sought to identify predictors of survival for acute decompensated HF (ADHF) patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients >18 years old treated at our institution with VA-ECMO from 2009 to 2018 for ADHF with CS were studied. Demographic, hemodynamic, and echocardiographic data were collected. The primary outcome was survival to discharge. Fifty-two patients received VA-ECMO for ADHF with CS; 24 (46.2%) survived. Seventeen (32.7%) had suffered cardiac arrest, and 37 (71.2%) were mechanically ventilated. Mean lactate was 4.33 ± 3.45 mmol/L, and patients were receiving 2.7 ± 1.2 vasopressor/inotropic infusions at ECMO initiation; these did not differ significantly between survivors and nonsurvivors. Pre-ECMO cardiac index was 1.84 ± 0.56L/min/m2 and 1.94 ± 0.63L/min/m2 in survivors and nonsurvivors, respectively (p = 0.57). In multivariable analysis, only diabetes mellitus (DM; OR, 13.25; CI, 1.42-123.40; p = 0.02) and mineralocorticoid receptor antagonist use (OR, 0.12; CI, 0.02-0.78; p = 0.03) were independent predictors of mortality. Nineteen (79.2%) survivors required durable ventricular assist device. Among ADHF patients receiving VA-ECMO, DM is a powerful predictor of outcomes while markers of clinical acuity including hemodynamics, vasopressor/inotrope use, and lactate are not. The vast majority of survivors required durable left-ventricular assist devices.

Original languageEnglish (US)
Pages (from-to)781-787
Number of pages7
JournalASAIO Journal
Volume65
Issue number8
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

Keywords

  • cardiogenic shock
  • ECPR
  • extra-corporeal membrane oxygenation
  • heart failure
  • INTERMACS 1
  • left ventricular assist device
  • venting

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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