Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience

Rahhal, A; Bilal, O; Salama, AM; Sivadasan, P; Abdullah, AA; Abuyousef, S; Shahulhameed, S; Zaza, KJ; Mulla, AA; Alkhulaifi, A; Mahfouz, A; Alyafei, S; Omar, A

doi:10.1053/j.jvca.2025.01.013

Organ support & nutrition

Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience

J Cardiothorac Vasc AnesthPublished 13 Jan 2025Retrospective observational case-control study

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Authors' conclusion

The mortality rate in CS requiring VA-ECMO, regardless of IABP use, remains high. However, only one predictor (ie, prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading

Study context

Population: Patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannulation, national tertiary cardiology center, 2016–2022
Participants: 110 patients

Comparison: VA-ECMO with vs without intra-aortic balloon pump (IABP)
Outcome: In-hospital 30-day mortality and its predictors (multivariate logistic regression)
Follow-up: 30 days

Methodological detailssingle national tertiary cardiology centre, multivariate logistic regression

Single national tertiary cardiology centre
Multivariate logistic regression

Main finding

As reported in the abstract

In-hospital 30-day mortality

VA-ECMO regardless of IABP42.7%

VA-ECMO and IABP46.9%

Observational data: associations, not effects.

Further findings

Predictors of mortality with VA-ECMO regardless of IABP · 30 days

	← Lower odds ←→ Higher odds →	aOR (95% CI)	P value
CPR >20 minutes	0.050.21520	14.74 (2.02–107.41)	P = 0.008
	0.050.21520Adjusted odds ratio (log scale)

Predictors of mortality with VA-ECMO and IABP · 30 days

	← Lower odds ←→ Higher odds →	aOR (95% CI)	P value
CPR >20 minutesOnly significant positive predictor	0.050.21520	12.45 (1.79–86.36)	P = 0.011
	0.050.21520Adjusted odds ratio (log scale)

Predictors of mortality with VA-ECMO regardless of IABP · 30 days

Older age (>55 years) and left main disease >50% stenosis associated with fourfold increase in odds of mortality

Original publication

Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience. J Cardiothorac Vasc Anesth. Published 13 January 2025. doi:10.1053/j.jvca.2025.01.013

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