Prognostic Factors for Survival After Extracorporeal Membrane Oxygenation for Cardiogenic Shock

The aim of this study is to examine factors that can predict mortality in patients that have veno-arterial extracorporeal membrane oxygenation (VA-ECMO) instituted for cardiogenic shock. A single-center, retrospective study of 127 patients who underwent VA-ECMO for cardiogenic shock between January 2003 and December 2017 was conducted. Eighty-three (65%) patients survived to weaning or bridging therapy. Complications on VA-ECMO include: hemorrhage (40%), stroke (14%), requirement for dialysis (42%), and limb ischemia (24%). Univariate analysis revealed shorter ECMO duration, higher body mass index, preimplantation creatinine > 100 mmol/l, lower preimplantation serum albumin, and the development of stroke or limb ischemia on ECMO to be significantly associated with mortality while on ECMO. Multivariate analysis by logistic regression found shorter ECMO duration and lower preimplantation serum albumin to be significantly associated with mortality. VA-ECMO is an effective strategy in treating patients with cardiogenic shock and provides a reasonable chance of survival to weaning or bridging to other therapy. Preimplantation hypoalbuminemia, preimplantation serum creatinine > 100 mmol/l, and the development of stroke and limb ischemia while on VA-ECMO are strongly associated with mortality.