Risk Factors for Perioperative Mortality in Postcardiotomy Patients with Extracorporeal Life Support

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to support patients with refractory postcardiotomy failure. Different risk factors are associated with higher mortality in critically ill patients with cardiogenic shock. The SAVE score was developed to predict survival from refractory cardiogenic shock requiring VA-ECMO. However, it needs to be proven in setting of postcardiotomy shock. We analyzed the association between different perioperative risk factors, laboratory values and in-hospital mortality.

Method: We retrospectively evaluated 217 patients (pts) between 01/09 and 12/20 requiring va-ECMO support due to postcardiotomy cardiogenic shock. We analyzed different preoperative risk factors, complications during surgery, and laboratory values in the first 72 hours after initiation of va-ECMO and examined possible correlations with survival and predictability of weaning from va-ECMO. The patients were categorized in two groups regarding in-hospital mortality as survivors (79 patients, 36.4%) and nonsurvivors (138 patients, 63.6%). Receiver operator characteristic (ROC) curves are used to assess the prognostic value of each performance assessment.

Results: Age, gender, and procedures did not differ among groups. A total of 39.2% of patients were successfully weaned from va-ECMO. Univariate und multivariate analyses indicated that SOFA score (OR: 1.338; 95% CI: 1.109–1.615), lack of IABP (OR: 0.351; 95% CI: 0.143–0.857), and addition of dialysis (OR: 4.260; 95% CI: 1.766–10.277) were reliable predictors of in-hospital mortality. Higher lactate concentrations within the first 12 hours after initiation of VA-ECMO support also predicted in-hospital mortality (OR: 1.217; 95% CI: 1.024–1.447). Measured AUC for SOFA score as in-hospital mortality predictor was 0.70 (p = 0.000), while SAVE score showed poor discrimination as predictor of in-hospital mortality with AUC 0.55.

Conclusion: VA-ECMO in postcardiotomy patients with cardiogenic shock still carries high intra-hospital mortality. SOFA score and serum lactate levels during the first 12 hours after VA-ECMO initiation is highly associated with in-hospital mortality. SAVE score was not a predictor of in-hospital mortality in our patient cohort. Addition of IABP might play an important role in improving survival in postcardiotomy shock.

Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022