Pulmonary Artery Pressures and Mortality During Venoarterial ECMO: An ELSO Registry Analysis

Author:

Owyang Clark G.12ORCID,Rippon Brady3,Teran Felipe2ORCID,Brodie Daniel4ORCID,Araos Joaquin5ORCID,Burkhoff Daniel6ORCID,Kim Jiwon7ORCID,Tonna Joseph E.8ORCID

Affiliation:

1. Division of Pulmonary and Critical Care Medicine, Department of Medicine (C.G.O.), New York-Presbyterian Hospital/Weill Cornell Medical College, New York.

2. Department of Emergency Medicine (C.G.O., F.T.), New York-Presbyterian Hospital/Weill Cornell Medical College, New York.

3. Department of Population Health Sciences, Weill Cornell Medical College, New York, NY (B.R.).

4. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD (D.B.).

5. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY (J.A.).

6. Cardiovascular Research Foundation, New York, NY (D.B.).

7. Division of Cardiology, Department of Medicine (J.K.), New York-Presbyterian Hospital/Weill Cornell Medical College, New York.

8. Division of Cardiothoracic Surgery, Department of Surgery, Department of Emergency Medicine, University of Utah Health, Salt Lake City (J.E.T.).

Abstract

BACKGROUND: Systemic hemodynamics and specific ventilator settings have been shown to predict survival during venoarterial extracorporeal membrane oxygenation (ECMO). How the right heart (the right ventricle and pulmonary artery) affect survival during venoarterial ECMO is unknown. We aimed to identify the relationship between right heart function with mortality and the duration of ECMO support. METHODS: Cardiac ECMO runs in adults from the Extracorporeal Life Support Organization Registry between 2010 and 2022 were queried. Right heart function was quantified via pulmonary artery pulse pressure (PAPP) for pre-ECMO and on-ECMO periods. A multivariable model was adjusted for modified Society for Cardiovascular Angiography and Interventions stage, age, sex, and concurrent clinical data (ie, pulmonary vasodilators and systemic pulse pressure). The primary outcome was in-hospital mortality. RESULTS: A total of 4442 ECMO runs met inclusion criteria and had documentation of hemodynamic and illness severity variables. The mortality rate was 55%; nonsurvivors were more likely to be older, have a worse Society for Cardiovascular Angiography and Interventions stage, and have longer pre-ECMO endotracheal intubation times ( P <0.05 for all) than survivors. Increasing PAPP from pre-ECMO to on-ECMO time (ΔPAPP) was associated with reduced mortality per 2 mm Hg increase (odds ratio, 0.98 [95% CI, 0.97–0.99]; P =0.002). Higher on-ECMO PAPP was associated with mortality reduction across quartiles with the greatest reduction in the third PAPP quartile (odds ratio, 0.75 [95% CI, 0.63–0.90]; P =0.002) and longer time on ECMO per 10 mm Hg (beta, 15 [95% CI, 7.7–21]; P <0.001). CONCLUSIONS: Early on-ECMO right heart function and interval improvement from pre-ECMO values were associated with mortality reduction during cardiac ECMO. Incorporation of right heart metrics into risk prediction models should be considered.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Predicting Survival on ECMO: The “Right” Parameters;Circulation: Heart Failure;2024-07

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