Outcomes and Factors Associated with Early Mortality in Patients Undergoing Distant ECMO Implantation and Transport to ECMO Centers - Strategies to Improve Results in Newly Launched Programs

Anton Sabashnikov, Ilja Djordjevic, Antje-Christin Deppe, Elmar W. Kuhn, Dirk Sindhu, Kaveh Eghbalzadeh, Julia Merkle, Carolyn Weber, Johanna Maier, Mohamed Zeriouh, Ferdinand Kuhn-Régnier, Navid Madeshahian, Yeong-Hoon Choi, Thorsten Wahlers

University Hospital Cologne, Cologne, Germany

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Background: ECMO transport has become a useful tool useful for emergent treatment of heart or lung failure, whereas the number of centers launching this service is still rapidly increasing. The main limitation of this strategy is high mortality which depends on logistical issues and patient condition. In this respect this study analyses outcomes and factors associated with early mortality in a newly launched ECMO retrieval service.

Methods: From 2015 till 2017 a total of 28 consecutive patients received ECMO support in peripheral hospitals using a miniaturized portable Cardiohelp System® (Maquet, Rastatt Germany) for heart, lung or heart/lung failure as a bridge-to-decision as a part of our newly launched ECMO retrieval service. Outcomes and predictors for 30-day mortality were analyzed.

Results: Implantations were performed in 15 distant departments with following transportation to our center with the median distance of 23(10;40) (maximum 60) km. The mean age was 56±15 years. The mean ECMO support duration was 97±100 hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without CPR was 61.5% at one week and 38.5% at 6 month and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 6 month and 1 year (Log-Rank p=0.374). Presence of hemolysis (p=0.041), renal failure (p=0.016), lower platelet count before ECMO implantation (p=0.001), and higher lactate 24 h after initiation of support (p=0.006) were factors associated with 30-day mortality.

Conclusions: Our data show that initial success of an ECMO retrieval service may depend on highly deleterious effects of hemodynamic malperfusion of end organs. Therefore, rapid initiation of ECMO support is a vital factor for survival. This is highlighted by predictive factors of early mortality that are associated with peripheral organ failure or complications.