Journal des soins intensifs et critiques Libre accès

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Identified Mortality Factors during Extracorporeal Membrane Oxygenation (ECMO)

Mario Alberto CT, Jesus Andres RC, Aaron RS, Wilfredo VM, René Daniel GG, Cesar David RH, Guillermo QV, MaríaVerónica CC

Introduction: ECMO mortality direct related variables were evaluated, specifically anti coagulation, Blood Lactate and Central Venous Saturation.

Materials & Methods: Fifty pediatric patients between 0 to 13 years old were included in a retrospective observational cohort study from January 1, 2013 to June 1, 2019 in 321 ECMO Center. Variables included were Activated Coagulation Time, Non-fractionated Heparin dose, ECMO type, ECMO time, Blood Lactate and Venous Saturation.

Results: Increased mortality (p>0.05) was not related to anti coagulation, heparin dose and ACT levels according to a Multiple Logistic Regression Model. Globally, 15% mortality was associated to ECMO type, blood lactate and central venous saturation. When variables were analyzed individually, survival in VA ECMO was 70% vs 20-30% survival in VV ECMO. In case of blood lactate, survival was 80% with 2 mmol/L, and survival decreased twofold with progressive increases. Important Central Venous Saturation decreases below 75%, like consecutive 5% decreases, are twofold related with less survival.

Conclusion: This study has evidently demonstrated that Extracorporeal Membrane Oxygenation (ECMO) use involves maximum responsibility in monitoring, along with a multidisciplinary management. Variables related to anticoagulation were not statistically important; 5% mortality was related to ECMO type, blood lactate, and central venous saturation, making mandatory to explore more about patient’s systemic perfusion management and hemodynamic monitoring, and anticoagulation as well, without losing track of its most common complications.