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Predictors of Survival to Discharge After Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Donghoon Kim, Soo Jin Na, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joong Hyun Ahn, Keumhee C. Carriere, Jeong Hoon Yang
Published: 10 October 2020
Circulation Journal ; doi:10.1253/circj.cj-20-0550

Abstract: Background:This study identified predictors of hospital mortality after successful weaning of patients with cardiogenic shock off venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support. Methods and Results:Adult patients who received peripheral VA ECMO from January 2012 to April 2017 were reviewed retrospectively. After excluding patients who died on ECMO support, predictors for survival to discharge were investigated in patients who were successfully weaned off ECMO. Of 191 patients successfully weaned off ECMO, 143 (74.9%) survived to discharge. The prevalence of a history of stroke and coronary artery disease, as well as ECMO-related complications, including newly developed stroke and sepsis, was a higher in patients who did not survive to discharge than in those who did. On the day of ECMO weaning, Sequential Organ Failure Assessment score and serum lactate were higher in patients who did not survive to discharge, although there was no significant difference in blood pressure and the use of vasoactive drugs between the 2 groups. On multivariable analysis, stroke and sepsis during ECMO support, a lower Glasgow Coma Scale and acute kidney injury requiring continuous renal replacement therapy after weaning were significant predictors for in-hospital mortality. Conclusions:Complications that occurred during ECMO and the presence of extracardiac organ dysfunction after weaning were associated with in-hospital mortality in patients with cardiogenic shock who were successfully weaned off ECMO.
Keywords: mortality / cardiogenic shock / extracorporeal membrane oxygenation

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