Predictors of complications related to venoarterial extracorporeal membrane oxygenation in adults: A multicenter retrospective cohort study

Abstract

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex technology associated with risks and complications.

Objective: To identify predictors of complications related to VA-ECMO in adults.

Methods: A retrospective cohort study, including 63 adult patients undergoing VA-ECMO, performed at two institutions in Brazil, from the time both centers implemented VA-ECMO (1999 in Institution A and 2012 in Institution B) treatment through March of 2018. The association between independent variables (institution, demographic, indications for ECMO, and pre-ECMO clinical characteristics) and the outcomes (neurological, renal, vascular, hemorrhagic, infectious, and mechanical complications) was investigated by means of multiple logistic regressions.

Results: Predictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR = 0.10; 95% CI 0.00-1.01; p = 0.049) and following heart or lung transplant (OR = 0.04; 95% CI 0.00-0.42; p = 0.018). The use of inotropes/vasopressors was a predictor of vascular complications (OR = 7.72; 95% CI 1.83-39.87; p = 0.008). The levels of CK-MB were a predictor of renal complications (OR = 0.87; 95% CI 0.72-0.97; p = 0.046). Predictors of infectious complications were total bilirubin (OR = 0.02; 95% CI 0.00-0.26; p = 0.038) and body weight odds (OR = 1.24; 95% CI 1.08-1.61; p = 0.028). Class III heart failure was a predictor of mechanical complications (OR = 0.07; 95% CI 0.00-0.66; p = 0.034).

Conclusion: Identifying predictors of complications may contribute to the indications for VA-ECMO.

Keywords: Adult; Complication; Extra corporeal membrane oxygenation; Risk factors.