Abstract
Abstract
Purpose
Veno-arterial extracorporeal oxygenation (VA-ECMO) provides comprehensive cardiopulmonary support in patients with cardiogenic shock (CS), but may result in complications. While complications rates are known, their impact on risk of death remains largely unknown.
Methods
Using the Extracorporeal Life Support Organization (ELSO) Registry to identify adults with a diagnosis of CS treated with VA-ECMO (2017–2024), we analyzed the association between timing and type of complication and in-hospital mortality using three methodologies: 1) Cox proportional hazards analysis, treating complications as time-dependent covariates; 2) Multi-State Model (MSM) analysis, treating complications as transient states and estimating the differential mortality rate from each of these states; and 3) landmark Kaplan Meier survival analysis, estimating conditional survival curves, given survival to 3 weeks, based on count and timing of complications.
Results
Among 22,547 patients (31.7% female), 12,094 (54%) died during index hospitalization. More non-survivors experienced complications than survivors (74% vs 54%), with all sub-types occurring more frequently. Neurologic complications increased the hazard of mortality by 3.6 (95% C.I 3.4 - 3.8). MSM analysis indicated that the absolute 30-day risk of mortality was greater if a patient had a complication, increasing from 48.6% (0 complications) to 93.1% with a neurologic complication. Landmark survival analysis demonstrated that patients without complications within the first 3 weeks had the highest conditional survival.
Conclusion
Complications on VA-ECMO have a significant and cumulative effect on in-hospital mortality, with a higher number associated with increased risk of death. Neurologic and pulmonary complications were associated with the greatest mortality risk.