Background
Methods
Study population
Study endpoints and clinical definitions
ECMO management
Statistical methods
Results
Baseline characteristics
Characteristics | Total study population (n = 240) |
---|---|
Baseline characteristics at hospital admission | |
Age, years, median (IQR) | 65 (55–72) |
Male sex, n (%) | 172 (72) |
EuroSCORE (additive), points (IQR) | 10 (8–13) |
Procedure duration, h:min (IQR) | 8:00 (6:08–9:37) |
Hypertension, n (%) | 169 (70) |
Diabetes, n (%) | 66 (28) |
Hypercholesterolemia, n (%) | 125 (52) |
Coronary artery disease, n (%) | 124 (52) |
Left ventricular ejection fraction | |
30–44 %, n (%) | 35 (15) |
< 30 %, n (%) | 94 (39) |
Creatinine, mg/dl (IQR) | 1.3 (1.1–1.8) |
eGFR, ml/min/1.73 m2 (IQR) | 51.3 (38.9–68.5) |
Blood urea nitrogen, mg/dl (IQR) | 24.2 (18.2–36.1) |
Cholesterol, mg/dl (IQR) | 143 (104–182) |
C-reactive protein, mg/dl (IQR) | 1.0 (0.3–4.3) |
White blood cells, g/L (IQR) | 8.0 (6.1–11.1) |
Thrombocytes, G/L (IQR) | 188 (134–241) |
Liver parameters | |
Bilirubin total, mg/dl (IQR) | 1.1 (0.6–1.6) |
Alkaline phosphatase, U/L (IQR) | 81 (61–110) |
Aspartate transaminase, U/L (IQR) | 33 (23–67) |
Alanine transaminase, U/L (IQR) | 27 (18–47) |
AST/ALT ratio, n (IQR) | 1.3 (0.9–2.1) |
γ-Glutamyl transferase, U/L (IQR) | 54 (32–105) |
Albumin, g/L (IQR) | 38.6 (30.8–42.4) |
Normotest, % (IQR) | 75 (50–94) |
Post-ECMO implantation (first 24 h) | |
SAPS-3, n (%) | 43 (36–51) |
SOFA score, n (IQR) | 12 (10–14) |
ECMO flow, L/min (IQR) | 3.36 (2.50–4.25) |
ECMO rotation, rpm (IQR) | 3000 (2485–3500) |
ECMO gas flow, L/minute (IQR) | 2.5 (2.0 − 3.0) |
ECMO FiO2, % (IQR) | 70 (60–100) |
ECMO duration, days, median (IQR) | 4 (3–7) |
Hemodynamic parameters (at ICU admission) | |
Mean arterial pressure, mmHg (IQR) | 72 (65–79) |
Cardiac output, L/minute | 3.9 (2.8–5.1) |
ScVO2, % (IQR) | 71 (64–77) |
Central venous pressure, mmHg (IQR) | 14 (11–16) |
Medication (first 24 h post-ECMO) | |
Noradrenaline, n (%) | 234 (98) |
Noradrenaline (maximum dose), μg/kg/minute | 0.28 (0.13–0.58) |
Dobutamine, n (%) | 218 (91) |
Dobutamine (maximum dose), μg/kg/minute | 4.78 (2.88–7.14) |
Vasopressin, n (%) | 85 (35) |
Vasopressin (maximum dose), U/h (IQR) | 3.0 (2.0–4.0) |
Liver function parameters and outcomes
30-day mortality | Long-term mortality | ||||
---|---|---|---|---|---|
Baseline parameters | SD | HR (95 % CI) |
P value | HR (95 % CI) |
P value |
Alkaline phosphatase, U/L | 68.9 | 1.23 (1.02–1.50) | 0.035 | 1.14 (0.95–1.38) | 0.16 |
Bilirubin total, mg/dl | 2.0 | 1.16 (1.02–1.32) | 0.028 | 1.15 (1.02–1.30) | 0.028 |
Aspartate transaminase, U/L | 303.5 | 1.08 (0.92–1.27) | 0.36 | 1.06 (0.91–1.23) | 0.45 |
Alanine transaminase, U/L | 192.0 | 1.07 (0.90–1.27) | 0.45 | 1.04 (0.90–1.21) | 0.60 |
AST/ALT ratio, n
| 1.9 | 0.97 (0.78–1.21) | 0.81 | 0.95 (0.80–1.12) | 0.51 |
γ-Glutamyl transferase, U/L | 133.3 | 1.07 (0.87–1.32) | 0.54 | 1.10 (0.94–1.29) | 0.22 |
Albumin, g/L | 8.7 | 0.83 (0.68–1.01) | 0.06 | 0.86 (0.74–1.00) | 0.049 |
Normotest, % | 30.0 | 1.02 (0.82–1.26) | 0.87 | 1.06 (0.90–1.24) | 0.50 |
30-day mortality | Long-term mortality | ||||
---|---|---|---|---|---|
Baseline parameters | SD | Adjusted HR (95 % CI) |
P value | Adjusted HR (95 % CI) |
P value |
Alkaline phosphatase, U/L | 68.9 | 1.36 (1.10–1.68) | 0.004 | 1.27 (1.03–1.56) | 0.023 |
Bilirubin total, mg/dl | 2.0 | 1.22 (1.07–1.40) | 0.004 | 1.22 (1.07–1.39) | 0.003 |
Aspartate transaminase, U/L | 303.5 | 1.07 (0.90–1.27) | 0.44 | 1.05 (0.91–1.22) | 0.48 |
Alanine transaminase, U/L | 192.0 | 1.11 (0.93–1.33) | 0.27 | 1.08 (0.93–1.26) | 0.30 |
AST/ALT ratio, n
| 1.9 | 0.90 (0.70–1.17) | 0.43 | 0.89 (0.74–1.08) | 0.24 |
γ-Glutamyl transferase, U/L | 133.3 | 1.09 (0.87–1.35) | 0.47 | 1.12 (0.95–1.31) | 0.18 |
Albumin, g/L | 8.7 | 0.81 (0.65–1.01) | 0.06 | 0.83 (0.71–0.98) | 0.028 |
Normotest, % | 30.0 | 1.03 (0.81–1.31) | 0.81 | 1.06 (0.88–1.26) | 0.56 |
Discussion
Conclusions
Key messages
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ECMO represents a valuable and rapidly evolving therapeutic option in patients with severe heart or lung failure following cardiovascular surgery.
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Alkaline phosphatase and total bilirubin are sensitive parameters for predicting short-term and long-term outcomes in patients undergoing ECMO support.
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Alkaline phosphatase and total bilirubin represent a valuable and easily available addition for comprehensive decision-making before ECMO implantation.