• Cecilia Li, Mehrnaz Pajoumand, Kerry Lambert, Laila Najia, Allison L Bathula, Michael A Mazzeffi, Samuel M Galvagno, Ali Tabatabai, Alison Grazioli, Siamak Dahi, Eric S Hochberg, and Michael E Plazak.
• Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
• J. Cardiothorac. Vasc. Anesth. 2022 Jun 1; 36 (6): 1648-1655.

ObjectiveTo explore if atrial arrhythmias are associated with in-hospital mortality in veno-venous extracorporeal membrane oxygenation (VV-ECMO) patients.DesignRetrospective observational cohort study.SettingQuaternary care academic medical center.ParticipantsPatients with respiratory failure requiring VV-ECMO for >24 hours between January 1, 2016, and January 1, 2019.InterventionsNone, observational study.Measurements And Main ResultsTwo hundred nineteen VV-ECMO patients were included. Patients were stratified by absence or presence of clinically significant atrial arrhythmias during the VV-ECMO run. Atrial arrhythmias were defined as either atrial fibrillation or atrial flutter that occurred during VV-ECMO and required pharmacologic or electrical intervention. The primary outcome was in-hospital mortality. Secondary outcomes included a composite of thrombotic events, which included ischemic stroke and on-pump arterial thrombosis. Other objectives of this analysis included characterization of atrial arrhythmia incidence, risk factors, and management. A total of 67 patients (30.5%) experienced new-onset atrial arrhythmias post-ECMO cannulation. Age, male sex, and norepinephrine use were independently associated with atrial arrhythmia development. In-hospital mortality was significantly higher in the atrial arrhythmia group (38.8% v 19.1%; p = 0.003). In the multivariate logistic regression analysis, atrial arrhythmias during VV-ECMO were independently associated with increased odds of in-hospital mortality (odds ratio, 2.21; 95% confidence interval, 1.08-4.55; p = 0.03), after controlling for Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score, acute renal failure, total norepinephrine dose, and total cannulation time.ConclusionsNew-onset atrial arrhythmias are a frequent complication during VV-ECMO and are independently associated with excessive in-hospital mortality. Thus, their presence may serve as an important prognostic tool in this patient population.Copyright © 2021 Elsevier Inc. All rights reserved.

16 keywords...

hide…