Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane oxygenation is predictive of death prior to hospital discharge, renal dysfunction requiring dialysis and pulmonary oedema

Abstract

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are titrated to achieve adequate perfusion while attempting to ideally maintain arterial pulse pressure (PP). We assessed risk in patients with low PP defined as <10 mmHg within the first 2 days of support. Methods Demographics, haemodynamics, echocardiographic and radiological findings were recorded retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital mortality, requirement for renal replacement therapy (RRT) and severe pulmonary oedema (PO). Results Of 101 patients, 66.3% were male, mean age was 56 (range 18–71 years), mean duration of support was 6.3 days ± 4.1 days, 37.6% died prior to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO were (respectively): 0.69 (95% CI 0.58–0.80, p = .001), 0.64 (95% CI 0.50–0.77, p = .044), 0.69 (95% CI 0.55–0.82, p = .009). The odds ratio for mortality, RRT, severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01–7.5, p = .04), 3.1 (95% CI 1.11–8.40, p = .026), 7.6 (95% CI 2.06–27.89, p = .001). Central venous pressure, mean arterial pressure were not predictive. Conclusion PP during the first 2 days of support is predictive of clinically important outcomes in patients supported with VA-ECMO.