Introduction: Mechanical circulatory support (MCS) has been established as a means
of augmenting circulation in patients with critically decreased systolic function
due to a variety of underlying clinical reasons. Different methods of MCS may be used,
with the venous-arterial extracorporeal membrane oxygenation system (VA-ECMO) being
one of the most utilized devices in everyday care. Aim: To determine independent predictors
influencing mortality outcomes following VA-ECMO therapy in a large, unselected, adult,
critically ill patient population in cardiogenic shock (CS). Material and methods:
Data on 235 consecutive, real-world VA-ECMO treatments were assessed. Analysis was
conducted for all subjects requiring MCS with the VA-ECMO as the first instalment,
regardless of underlying cause or eventual upgrade. All potential clinical factors
influencing mortality were examined and evaluated. Results: Overall mortality was
similar to 66% at median 28 days follow-up and significantly depended upon pH < 7.3
(HR = 3.56; p < 0.001), and age >= 65 years (HR = 1.96; p = 0.001). Acute coronary
syndrome (ACS) as an indication for VA-ECMO displayed a nearly significant value (HR
= 1.44; p = 0.07). Heart transplant (hTX) primary graft failure as an indication for
the VA-ECMO displayed a clearly favorable outcome (HR = 0.51, p = 0.025); all data
based on multivariate Cox regression analysis. Conclusions: Mortality in patients
requiring VA-ECMO remains high. We conclude that only decreased pH values and advanced
age clearly influence mortality in this MCS scenario. ACS also bodes unfavorably,
whereas hTX as an indication clearly shows better survival.
