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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