• Journal of critical care · Aug 2017

    Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.

    • Francischetti Ivo M B IMB Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States. Electronic address: Ivf, James Szymanski, Daniel Rodriguez, Moonseong Heo, and Lucia R Wolgast.
    • Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States. Electronic address: Ivfranci@montefiore.org.
    • J Crit Care. 2017 Aug 1; 40: 136-144.

    PurposeSurvival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care.Materials And MethodsClinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007-2014).ResultsOur population comprises of 166 adults and was divided in survivors and non-survivors, within 30days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (<10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45yo vs 55yo, p=0.0001) and higher systolic blood pressure (115mmHg vs 103mmHg, p=0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p=0.0003), chloride (p=0.009), bicarbonate (p=0.015) and pH (p=0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02-1.13; p=0.004), pH (OR 3.35; 95% CI 1.89-5.9; p<0.0001) and aPTT (OR 0.98; 95% CI 0.976-0.998; p=0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06-3.34; p=0.029).ConclusionsLaboratory markers identified herein may guide the management of patients on ECMO.Copyright © 2017 Elsevier Inc. All rights reserved.

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