"Early vs Late Extracorporeal Membrane Oxygenation (ECMO) for Mechanica" by Manoj Kumar, Shafaqat Ali et al.
 

Abstract

Background

Use of Extracorporeal membrane oxygenation (ECMO) for hemodynamic (HD) support is becoming increasingly prevalent. While potentially life-saving, ECMO use is associated with complications of its own due to widespread immune activation. We aim to compare early (≤1 day) vs late (>1 day) ECMO use for hemodynamic support.

Methods

The national readmission database (2016-2020) was utilized to identify hospitalizations requiring ECMO. Cohorts were stratified based on ECMO initiation. A Propensity Score Matching (PSM) model matched patients with early vs late ECMO use. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes.

Results

Among 40,984 hospitalizations requiring ECMO for HD support; About 21.2% (N: 8,688) had early ECMO initiation. After propensity matching, early ECMO use was found to be associated with a higher incidence of stroke (6.9% vs. 4.6%), sudden cardiac arrest (11.7% vs 8.6%), post-procedural bleeding (5.8% vs 4.8%), vascular complications (2.5% vs 1.9%), acute MI (21% vs 16.2%), AKI (56.7% vs 55.6%), respiratory failure (45.9% vs 36.5%), MACCE (46.4% vs 40.8%) & need for vasopressors (18.4% vs 15.4%) [p<0.001]. Mortality was similar between two cohorts (p>0.05). Mortality in HD unstable patients requiring ECMO has increased from 4.2% in 2016 to 36.6% in 2020 (p-trend <0.001). Early ECMO use was also associated with higher readmission rates at 30-day (14.4% vs 12.4%, p<0.001), 90-day & 180-day intervals but with lower LOS (9 vs 19 days) & cost of hospitalization [p<0.001].

Conclusions

Early ECMO use is associated with much higher complication & readmission rates, although mortality is not different.

Document Type

Meeting Abstract

Publication Date

5-2024

Publication Title

JSCAI

First Page

101715

Last Page

101715

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