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

Abstract

INTRODUCTION\nVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex technology associated with risks and complications.\n\n\nOBJECTIVE\nTo identify predictors of complications related to VA-ECMO in adults.\n\n\nMETHODS\nA 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.\n\n\nRESULTS\nPredictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR\xa0=\xa00.10; 95% CI 0.00-1.01; p\u202f=\u202f0.049) and following heart or lung transplant (OR\u202f=\u202f0.04; 95% CI 0.00-0.42; p\u202f=\u202f0.018). The use of inotropes/vasopressors was a predictor of vascular complications (OR\u202f=\u202f7.72; 95% CI 1.83-39.87; p\u202f=\u202f0.008). The levels of CK-MB were a predictor of renal complications (OR\u202f=\u202f0.87; 95% CI 0.72-0.97; p\u202f=\u202f0.046). Predictors of infectious complications were total bilirubin (OR\u202f=\u202f0.02; 95% CI 0.00-0.26; p\u202f=\u202f0.038) and body weight odds (OR\u202f=\u202f1.24; 95% CI 1.08-1.61; p\u202f=\u202f0.028). Class III heart failure was a predictor of mechanical complications (OR\u202f=\u202f0.07; 95% CI 0.00-0.66; p\u202f=\u202f0.034).\n\n\nCONCLUSION\nIdentifying predictors of complications may contribute to the indications for VA-ECMO.