Outcomes, Temporal Trends, And Resource Utilization In Ischemic Vs Non-ischemic Cardiogenic Shock
HFSA ePoster Library. Aurora L. 09/10/21; 343334; 112
Lindsey Aurora
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Abstract
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Background: Several mortality prediction models exist for patients on Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), including the Survival after VA ECMO (SAVE) Score. Whether additional characteristics, such as body surface area (BSA), race, gender, Hispanic ethnicity, and dialysis history, affect mortality of VA ECMO patients are not as well understood. This study thus assessed such prognostic factors in these patients.
Methods: A retrospective single-institutional study collected all consecutive non-pediatric patients who received VA ECMO between 2016-2020. 410 patients were identified. We excluded 13 patients who were transitioned to or from VA ECMO. Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis.
Results: 264 (64.4%) of VA ECMO patients did not survive until hospital discharge. Median age amongst VA patients was 59 years old, and median BSA was 2.10 m2. 339 (82.7%), 55 (13.4%), and 16 (3.90%) of patients were white, black, and other race, respectively. 13 (3.17%) were of Hispanic ethnicity and 130 (31.7%) were female. 158 (38.5%) and 31 (7.56%) had undergone a cardiotomy or heart transplant, respectively. A multiple logistic regression model assessing survival to hospital discharge was created, incorporating 11 covariates and with a model Likelihood Ratio chi-square test of 61.8 (p < 0.001). Patient age less than 55 years old was significantly associated with improved odds of survival to hospital discharge (adjusted odds ratio, 3.07; 95% confidence interval, 1.88 to 5.04). Two covariates were significantly associated with decreased odds of survival to hospital discharge: history of dialysis (adjusted odds ratio, 0.31; 95% confidence interval 0.11 to 0.99); and, if patient had a cardiac arrest (adjusted odds ratio, 0.42; 95% confidence interval 0.23 to 0.78).
Conclusion: Age < 55 years old was associated with improved prognosis, while history of dialysis and presence of cardiac arrest were associated with worse prognosis. Race, gender, BSA, and history of cardiotomy or heart transplant were not significantly associated with survival to hospital discharge in this cohort of VA ECMO patients.
Methods: A retrospective single-institutional study collected all consecutive non-pediatric patients who received VA ECMO between 2016-2020. 410 patients were identified. We excluded 13 patients who were transitioned to or from VA ECMO. Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis.
Results: 264 (64.4%) of VA ECMO patients did not survive until hospital discharge. Median age amongst VA patients was 59 years old, and median BSA was 2.10 m2. 339 (82.7%), 55 (13.4%), and 16 (3.90%) of patients were white, black, and other race, respectively. 13 (3.17%) were of Hispanic ethnicity and 130 (31.7%) were female. 158 (38.5%) and 31 (7.56%) had undergone a cardiotomy or heart transplant, respectively. A multiple logistic regression model assessing survival to hospital discharge was created, incorporating 11 covariates and with a model Likelihood Ratio chi-square test of 61.8 (p < 0.001). Patient age less than 55 years old was significantly associated with improved odds of survival to hospital discharge (adjusted odds ratio, 3.07; 95% confidence interval, 1.88 to 5.04). Two covariates were significantly associated with decreased odds of survival to hospital discharge: history of dialysis (adjusted odds ratio, 0.31; 95% confidence interval 0.11 to 0.99); and, if patient had a cardiac arrest (adjusted odds ratio, 0.42; 95% confidence interval 0.23 to 0.78).
Conclusion: Age < 55 years old was associated with improved prognosis, while history of dialysis and presence of cardiac arrest were associated with worse prognosis. Race, gender, BSA, and history of cardiotomy or heart transplant were not significantly associated with survival to hospital discharge in this cohort of VA ECMO patients.
Background: Several mortality prediction models exist for patients on Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), including the Survival after VA ECMO (SAVE) Score. Whether additional characteristics, such as body surface area (BSA), race, gender, Hispanic ethnicity, and dialysis history, affect mortality of VA ECMO patients are not as well understood. This study thus assessed such prognostic factors in these patients.
Methods: A retrospective single-institutional study collected all consecutive non-pediatric patients who received VA ECMO between 2016-2020. 410 patients were identified. We excluded 13 patients who were transitioned to or from VA ECMO. Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis.
Results: 264 (64.4%) of VA ECMO patients did not survive until hospital discharge. Median age amongst VA patients was 59 years old, and median BSA was 2.10 m2. 339 (82.7%), 55 (13.4%), and 16 (3.90%) of patients were white, black, and other race, respectively. 13 (3.17%) were of Hispanic ethnicity and 130 (31.7%) were female. 158 (38.5%) and 31 (7.56%) had undergone a cardiotomy or heart transplant, respectively. A multiple logistic regression model assessing survival to hospital discharge was created, incorporating 11 covariates and with a model Likelihood Ratio chi-square test of 61.8 (p < 0.001). Patient age less than 55 years old was significantly associated with improved odds of survival to hospital discharge (adjusted odds ratio, 3.07; 95% confidence interval, 1.88 to 5.04). Two covariates were significantly associated with decreased odds of survival to hospital discharge: history of dialysis (adjusted odds ratio, 0.31; 95% confidence interval 0.11 to 0.99); and, if patient had a cardiac arrest (adjusted odds ratio, 0.42; 95% confidence interval 0.23 to 0.78).
Conclusion: Age < 55 years old was associated with improved prognosis, while history of dialysis and presence of cardiac arrest were associated with worse prognosis. Race, gender, BSA, and history of cardiotomy or heart transplant were not significantly associated with survival to hospital discharge in this cohort of VA ECMO patients.
Methods: A retrospective single-institutional study collected all consecutive non-pediatric patients who received VA ECMO between 2016-2020. 410 patients were identified. We excluded 13 patients who were transitioned to or from VA ECMO. Univariate and multivariate analyses were performed. The risk factors affecting survival to hospital discharge were determined by multiple logistic regression analysis.
Results: 264 (64.4%) of VA ECMO patients did not survive until hospital discharge. Median age amongst VA patients was 59 years old, and median BSA was 2.10 m2. 339 (82.7%), 55 (13.4%), and 16 (3.90%) of patients were white, black, and other race, respectively. 13 (3.17%) were of Hispanic ethnicity and 130 (31.7%) were female. 158 (38.5%) and 31 (7.56%) had undergone a cardiotomy or heart transplant, respectively. A multiple logistic regression model assessing survival to hospital discharge was created, incorporating 11 covariates and with a model Likelihood Ratio chi-square test of 61.8 (p < 0.001). Patient age less than 55 years old was significantly associated with improved odds of survival to hospital discharge (adjusted odds ratio, 3.07; 95% confidence interval, 1.88 to 5.04). Two covariates were significantly associated with decreased odds of survival to hospital discharge: history of dialysis (adjusted odds ratio, 0.31; 95% confidence interval 0.11 to 0.99); and, if patient had a cardiac arrest (adjusted odds ratio, 0.42; 95% confidence interval 0.23 to 0.78).
Conclusion: Age < 55 years old was associated with improved prognosis, while history of dialysis and presence of cardiac arrest were associated with worse prognosis. Race, gender, BSA, and history of cardiotomy or heart transplant were not significantly associated with survival to hospital discharge in this cohort of VA ECMO patients.
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