Contemporary Use of Venoarterial Extracorporeal Membrane Oxygenation: Insights from the Multicenter RESCUE Registry |
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| Authors: | Rahul S. Loungani Marat Fudim Dave Ranney Ajar Kochar Marc D. Samsky Desiree Bonadonna Akinobu Itoh Hiroo Takayama Koji Takeda Daniel Wojdyla Adam D. DeVore Mani Daneshmand |
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| Affiliation: | 1. Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina;2. Department of Surgery, Duke University School of Medicine, Durham, North Carolina;3. Division of Cardiology, Brigham and Women''s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts;4. Department of Surgery, Washington University School of Medicine, St Louis, Missouri;5. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York;6. Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia;1. Saint Luke''s Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri;2. Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora;3. Division of Cardiology, University of Colorado School of Medicine, Aurora;4. Veterans Affairs, Eastern Colorado Geriatric Research Education and Clinical Center, Denver;5. Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado;1. McGaw Medical Center of Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, Illinois;2. Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;5. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;6. Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina;7. Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;8. Division of Nephrology, Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois;1. Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud;2. French National Health Insurance (Cnam), Paris, France;3. French Public Health Agency (Santé Publique France), Saint-Maurice, France;4. Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France;1. Department of Medicine, Karolinska Institute, Stockholm, Sweden;2. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden;3. Heart and Vascular Center, Semmelweis University, Budapest, Hungary;4. Centre for Foetal Medicine, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden |
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| Abstract: | BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge.Methods and ResultsWe created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at 3 high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were postcardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% of patients (n = 290) survived to discharge, with a minority receiving durable cardiac support (left ventricular assist device [n = 48] or heart transplantation [n = 7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.12–1.42) and female sex (OR, 1.44; 95% CI, 1.02–2.02) and risk factors for mortality after decannulation as higher body mass index (OR 1.17; 95% CI, 1.01-1.35) and major bleeding while on ECMO support (OR, 1.92; 95% CI, 1.23–2.99).ConclusionsDespite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. The optimization of outcomes will require refinements in patient selection and improvement of care delivery. |
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