Background
Methods
Study population
ECMO implantation techniques
Patient management
Main aims and definitions
Statistical analysis
Results
Patient demographics, pre-ECMO characteristics, and ECMO variables
Variable | With vascular complications (n = 72) n (%) | Without vascular complications (n = 360) n (%) | P value |
---|---|---|---|
Baseline characteristics
| |||
Male | 52 (72.2%) | 233 (64.7%) | 0.220 |
Age (years) | 57(48.3, 65.0) | 57(47.3, 65.0) | 0.905 |
Older age (≥ 65 years) | 19 (26.4%) | 101 (28.1%) | 0.773 |
BSA (m2) | 1.9 (1.8, 2.0) | 1.8 (1.7, 2.0) | 0.009 |
BMI (kg/m2) | 25.0 ± 3.7 | 23.6 ± 3.4 | 0.002 |
Smoking | 34 (47.2%) | 145 (40.3%) | 0.275 |
Comorbidities
| |||
Coronary artery disease | 42 (58.3%) | 176 (48.9%) | 0.143 |
Peripheral vascular disease | 12 (16.7%) | 46 (12.8%) | 0.377 |
Hypertension | 32 (44.4%) | 140 (38.9%) | 0.356 |
Diabetes | 15 (20.8%) | 75 (20.8%) | 1.000 |
Hypercholesterolemia | 61 (8.5%) | 260 (7.2%) | 0.718 |
Chronic obstructive lung disease | 10 (1.4%) | 50 (1.4%) | 0.998 |
Liver dysfunction | 10 (1.4%) | 2 (0.6%) | 0.437 |
APACHE II score | 32.8 ± 5.2 | 30.8 ± 7.1 | 0.448 |
Type of surgery
| |||
CABG | 35 (48.6%) | 142 (39.4%) | 0.149 |
Valve procedure | 17 (23.6%) | 105 (29.2%) | 0.339 |
CABG + valve procedure | 8 (11.1%) | 37 (10.3%) | 0.833 |
Congenital heart disease | 0 | 16 (4.4%) | 0.068 |
Repair of acute aortic dissection | 4 (5.6%) | 18 (5.0%) | 0.845 |
Repair of acute aortic dissection + CABG | 4 (5.6%) | 8 (2.2%) | 0.116 |
Heart transplantation | 3 (4.2%) | 18 (5.0%) | 0.761 |
Pulmonary embolectomy | 1 (1.4%) | 9 (2.5%) | 0.567 |
Others | 0 | 6 (1.7%) | 0.270 |
Reoperation | 20 (2.8%) | 12 (3.3%) | 0.808 |
Variable | With vascular complications (n = 72) n (%) | Without vascular complications (n = 360) n (%) | P value |
---|---|---|---|
ECMO implantation
| |||
Failure to wean off CPB | 40 (55.6%) | 198 (55.0%) | 0.932 |
LCOS in ICU | 32 (44.4%) | 162 (45.0%) | 0.932 |
Inotrope scores | 52.5 ± 11.2 | 38.3 ± 12.9 | 0.008 |
Lactate at ECMO initiation (mmol/L) | 11.0 (7.8, 14.3) | 9.5 (6.9, 12.8) | 0.035 |
Peak lactate during ECMO (mmol/L) | 16.2 (13.6, 20.8) | 15.2 (11.5, 18.5) | 0.004 |
SOFA score at ECMO initiation | 13.0 (12.0, 13.0) | 12.0 (11.0, 13.0) | < 0.001 |
SOFA score at 24 h post-ECMO | 11.0 (10.0, 11.0) | 9.0 (7.0, 11.0) | < 0.001 |
Arterial cannula size, Fr | 16.5 ± 0.6 | 16.1 ± 0.7 | 0.467 |
Ongoing CPR | 13 (18.1%) | 56 (15.6%) | 0.597 |
IABP support | 45 (62.5%) | 200 (55.6%) | 0.280 |
ECMO outcomes
| |||
Weaning from ECMO | 24 (33.3%) | 228 (63.3%) | < 0.001 |
Survival to discharge | 12 (16.7%) | 141 (39.2%) | < 0.001 |
Duration of ECMO (days) | 2.9 (1.6, 5.4) | 3.8 (2.2, 5.5) | 0.204 |
Complications
| |||
Renal failure required CRRT | 38 (52.1%) | 171 (47.6%) | 0.490 |
Neurologic complications | 11 (15.3%) | 56 (15.6%) | 0.953 |
DIC | 3 (4.2%) | 6 (1.7%) | 0.177 |
Severe bleeding | 16 (22.2%) | 47 (13.1%) | 0.044 |
Tracheostomy | 27 (37.5%) | 140 (39.0%) | 0.812 |
Repeat thoracotomy | 37 (51.4%) | 132 (36.7%) | 0.019 |
Femoral site infection | 6 (8.3%) | 25 (7.0%) | 0.681 |
Sepsis | 13 (18.1%) | 84 (23.3%) | 0.335 |
Medical resources
| |||
PRBC transfusion (units) | 28.0 (19.3, 35.8) | 22.0 (14.0, 32.0) | 0.002 |
FFP | 2400 (1600, 3600) | 2000 (1400, 3000) | 0.076 |
Platelets | 3.0 (1.0, 5.0) | 3.0 (1.0, 5.0) | 0.578 |
Duration of MV | 94.5 (38.8, 191.3) | 120.0 (51.0, 210.0) | 0.018 |
ICU stay (days) | 107.0 (44.8, 237.4) | 168.0 (95.0, 255.8) | 0.007 |
Post-ECMO hospital stay (days) | 0 (0, 7.8) | 7 (0, 15.8) | < 0.001 |
Hospital stay (days) | 17.0 (11.0, 25.8) | 23.0 (16.0, 34.8) | 0.001 |
Occurrence rate of MVCs
Predisposing factors for MVCs
Factor | Univariable analysis OR [95% CI], p value | Multivariable analysis OR [95% CI], p value |
---|---|---|
Severe limb ischemia
| ||
Peripheral artery disease | 0.73 [0.37–1.46] 0.378 | |
Hypertension | 0.79 [0.47–1.31] 0.356 | |
Hypercholesterolemia | 0.84 [0.33–2.13] 0.718 | |
Smoking | 0.75 [0.45–1.25] 0.276 | |
Obesity | 3.47 [1.20–10.03] 0.005 | 2.65 [1.26–5.56] 0.010 |
Coronary artery disease | 2.47 [1.19–5.14] 0.022 | |
Diabetes | 0.86 [0.68–3.14] 0.326 | |
Combined with IABP | 2.97 [1.33–6.67] 0.018 | 2.49 [1.19–2.65] 0.025 |
ECPR | 0.83 [0.43–1.63] 0.597 | |
Lactate at ECMO initiation | 1.07 [0.98–1.14] 0.052 | |
Peak lactate during ECMO | 1.10 [1.03–1.16] 0.002 | |
SOFA score at ECMO initiation | 2.09 [1.60–2.23] < 0.001 | |
SOFA score at 24 h post-ECMO | 1.67 [1.41–1.98] < 0.001 | 1.43 [1.08–1.86] 0.010 |
Cannulation site bleeding
| ||
Hemostasis disorders during ECMO | 7.21 [2.28–22.77] < 0.001 | 6.11 [1.88–19.87] < 0.001 |
Impact of MVCs on survival
Variable | Odds ratio | 95% confidence interval | p value |
---|---|---|---|
Major vascular complications | 3.91 | 1.67–9.14 | 0.013 |
Renal failure required CRRT | 10.98 | 6.21–19.41 | < 0.001 |
Severe bleeding | 15.86 | 3.61–69.63 | < 0.001 |
Neurologic complications | 13.68 | 5.38–34.80 | < 0.001 |