Mani Latifi, MD
Staff
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Leslie Tolle, MD
Assistant Professor
Cleveland Clinic, United States
Disclosure information not submitted.
Charles Lane, MD
Assistant Professor
Cleveland Clinic, United States
Disclosure information not submitted.
Ajit Moghekar, MD, MBA
Staff Physician
Cleveland Clinic, United States
Disclosure information not submitted.
Eduardo Mireles-Cabodevila, MD
Director , Medical Intensive Care Unit
Cleveland Clinic - Respiratory Institute
Cleveland, Ohio
Disclosure information not submitted.
Abhijit Duggal, MD, MPH, MSc, FACP
Assistant Professor
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Sudhir Krishnan, MD
Pulmonary and Critical Care Medicine Attending
Cleveland Clinic, Ohio, United States
Disclosure information not submitted.
Title: Characteristics and Outcomes in patients selected for Veno-Venous ECMO at Cleveland Clinic
Introduction:
At our institution, we established a sub-specialist critical care pulmonology led VV ECMO program and investigated the utility of a multivariable selection model comprising prognostic scores of illness, ECMO selection scores (RESP and PRESERVE), ABG thresholds, hemodynamics, echocardiographic features and vasopressor use. The goal of this study was to analyze baseline characteristics of patients, identify variables that impact eligibility for VV ECMO, use of adjunctive therapies prior to ECMO initiation and survival rate in those selected.
Methods:
Prospective evaluation of 205 patients who were referred for ECMO evaluations at the Main Campus (Jan 2017 to May 2021). Predetermined variables were extracted from the EMR. Baseline characteristics, ECMO candidacy and outcomes were assessed.
Results:
Among 205 patients who were evaluated, 116 patients (56.5%) were considered to be VV ECMO candidates. ECMO candidates (in comparison to those not selected) were younger with a mean age (SD) of 46.4 (16.4) vs 50.1 (14.5), 58 (50%) were males vs 51 (57.3), 83 (71.6%) were Caucasian vs 65 (73%), mean (SD) BMI was 31.9 (8.2) vs 39.1 (15.5), mean (SD) days in ARDS were 4.4 (5.7) vs 4.5 (3.9) and mean (SD) days of MV were 3.0 (4.6) vs 4.4 (4.5). The mean(SD) p/F ratio in the ECMO candidate group was 136.7 (98.7) vs 113.7 (67.6). LV function was decreased in 10 (13.7%) of the ECMO candidates vs 16 (27.6%). Twenty (17.2%) of the ECMO candidates were proned prior to their evaluation vs 17 (19.1%), inhaled epoprostenol was used in 41 (35.3%) vs 31 (34.8%), 57 (49.1%) vs 44 (49.4%) were on steroids, 73 (63.5%) were on paralytics vs 56 (63.6%). The mean (SD) PRESERVE score was 3.7 (2.5) in the ECMO candidates vs 4.0 (2.4) and the mean (SD) RESP score vs 2.2 (4.0) vs -0.5 (4.4). Sixty-three (54.3%) were eventually committed to VV ECMO with a mean (SD) duration of 17.4 (17.2) days on the circuit and an in-hospital survival rate of 53.1% .
Conclusions:
Only 2/3rd of patients referred for ECMO evaluation were considered as candidates. However only 1/3 rd were finally cannulated with survival rate of 53%. Utilization of adjunctive therapies prior to ECMO initiation with proven mortality is low. In hospital survival rates approximate those predicted by the mean RESP score.