Hemodynamic Support and Cardiogenic Shock
Clinical Predictors of Successful Weaning VA-ECMO
Sheng-Fu Liu1, Chih Yu Hsu1, Chih-Kuo Lee1, Paul Hsien-Li Kao1
National Taiwan University Hospital, Taiwan1
Extracorporeal membrane oxygenation (ECMO) has been used clinically for more than fifty years. It played an important role in patients with cardiogenic shock state. ECMO has been successfully used as a bridge to myocardial recovery. If myocardial injury couldn’t be recovered, it could be as a bridge to definite therapies, like cardiac transplantation, or implantation of a ventricular assist device (VAD). To date, there is no study which was specifically designed to predict which patients can be successfully weaned off ECMO. Besides, there was either no standard weaning procedure currently. This study objectives are to test daily clinical parameters, which are associated with successfully ECMO weaning.
We reviewed and collected the patients’ clinically data, at the time of ECMO onset in NTUH HC branch retrospectively, in 2010 ~ 2017. The following data were recorded: baseline characteristics, indication for ECMO, ECMO durations, serious complications, blood routine and biochemistry, urine output, hemodynamic parameters (blood pressure, pulse pressure, central venous pressure, heart rate) , heart rhythm, inotropine equivalent, echocardiographic parameters. Blood routine and biochemistry includes CBC, liver and renal function, lactate, lactate clearance, arterial gas analysis, PaO2 / FiO2 ratio, peak CK/CKMB/Troponin-T level, etc.
35 subjects had been collected in this project. There were 24 cases in successful weaning group, and 11 in weaning failure group. Demographic information and clinical conditions were no significant difference between both of the groups. The possible weaning predictors were BSA (HR 65.17, 95% CI 3.01-1412.04, p = 0.008)、Chronic lung disease (HR 0.1, 95% CI 0.01-0.78, p = 0.02)、Atrial fibrillation (HR 0.33, 95%CI = 0.12-0.92, p = 0.03)、CVP level (HR = 0.89, 95% CI 0.8-0.99, p = 0.03)、Heart rate (HR 0.95, 95% CI 0.92-0.99, p = 0.007)、Peak T-bil (HR 0.92, 95% CI = 0.85-0.99, p = 0.05) by univariate analysis. The only independent predictor was heart rate on the day with the first intent of decannulation of VA-ECMO after multivariate analysis (HR 0.95, 95% CI 0.91-0.99, p = 0.029).
In conclusion, heart rate on the day with the first intent of decannulation of Veno-arterial-Extracorporeal membrane oxygenation (VA-ECMO) can predict better successful decannulation.