• Michael E Plazak, Alison Grazioli, Elizabeth K Powell, Ashley R Menne, Allison L Bathula, Ronson J Madathil, Eric M Krause, Kristopher B Deatrick, and Michael A Mazzeffi.
• Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
• J. Cardiothorac. Vasc. Anesth. 2022 Apr 1; 36 (4): 1092-1099.

ObjectivesTo explore whether precannulation international normalized ratio (INR) is associated with in-hospital mortality in venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients.DesignA retrospective, observational cohort study.SettingA quaternary care academic medical center.ParticipantsPatients with cardiogenic shock on VA-ECMO for >24 hours.InterventionsNone, observational study.Measurements And Main ResultsA total of 188 patients who were on VA-ECMO were included over three years. Patients were stratified into three groups based on their pre-ECMO INR: INR <1.5, INR 1.5 to 1.8, and INR >1.8. For all patients, demographics, comorbidities, and ECMO details were recorded. The study's primary outcome was in-hospital mortality and secondary outcomes included major bleeding, minor bleeding, allogeneic transfusion, ischemic stroke, intracranial hemorrhage, acute renal failure, acute liver failure, gastrointestinal bleeding, intensive care unit and hospital lengths of stay. A multivariate logistic regression was used to determine whether precannulation INR was associated independently with in-hospital mortality. In-hospital mortality differed significantly by INR group (51.6% INR >1.8 v 42.3% INR 1.5-1.8 v 24.3% INR <1.5; p = 0.004). In a multivariate logistic regression model, precannulation INR >1.8 was associated independently with an increased odds of mortality (odds ratio, 2.48; 95% confidence interval, 1.05-6.04) after controlling for sex, Survival after VA- ECMO score, and ECMO indication. An INR within 1.5 to 1.8 did not confer an increased mortality risk.ConclusionsAn INR >1.8 before VA-ECMO cannulation is associated independently with in-hospital mortality. Precannulation INR should be considered by clinicians so that ECMO resources can be better allocated and risks of organ failure and intracranial hemorrhage can be better understood.Copyright © 2021 Elsevier Inc. All rights reserved.

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