Cardiogenic shock and extracorporeal membrane oxygenation: etiology and 1-year survival

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Objectives Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to provide cardiorespiratory support in cardiogenic shock, but selection of patients and timing of ECMO-start remains a challenge. This study aims to describe the 1 year outcome of VA-ECMO for cardiogenic shock with focus on etiology and severity of shock.Methods VA-ECMO was used on 371 occasions between 2004 and 2019 at our centre. Of these, 177 patients received VA-ECMO for cardiogenic shock and were included in this retrospective single-center study. Univariable and multivariable logistic regression models were used to determine risk factors for all-cause mortality at 1 year.Results Patients were grouped according to etiology: non-ishcemic heart failure (NIHF, N = 49), ischemic heart disease (IHD, N = 83) and miscellaneous diagnoses (Misc, N = 45). Markers of disease severity were lower for patients with NIHF. One year survival was 40% for all patients, 57%, 36% and 27% for the NIHF-, IHD and Misc-groups, respectively (p < 0.01). Univariable logistic regression analysis identified several variables associated with 1-year mortality, such as etiology, pH and lactate, while biventricular failure was associated with a better prognosis. However, in the multivariable analysis only ECPR remained significantly associated with increased mortality (OR 3.67, (CI 1.66-8.31), p <0.01)Conclusion In this retrospective study of VA-ECMO for cardiogenic shock, we found an acceptable one-year survival rate of 40%, with a more favorable outcome for NIHF-patients. The negative association of ECPR with a higher 1 year mortality suggests the importance of patient selection as well as timing of the VA-ECMO before deterioration to cardiac arrest.

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