Blood Product Administration and Kidney Function as a Mortality Indicator for VA-ECMO: A Retrospective Review of a Single Institution

Abstract

Background Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a rapidly growing treatment for critically ill patients. The management of this life-saving therapy is extremely complicated; requiring highly trained professionals in the intensive care unit. Since the epidemic of influenza A in 2009, the usage of ECMO has increased by a 1000 fold. Unfortunately, the research and data is not able to keep up. Herein, we aim to increase this data with our own and look for markers that show an increase risk of mortality. We especially want to take note of blood product usage, kidney function, and patient platelet counts as indicators for increased mortality. Methods This is a retrospective analysis of patients that underwent VA ECMO treatment at Banner University Medical Center – Tucson, during the time period of January 2010 – December 2015. We disqualified patients that were on VA ECMO for less than 22 hours, as we felt this was not long enough of a time period to allow the changes we were hoping to discern. Data from the remaining 70 patients (32F/38M), median age 44 (11 – 61.5) years, was obtained by chart review. Patients were separated into two groups: those who survived until discharge (survivors, N = 25), and those who did not (nonsurvivors, N = 45). Results Our VA ECMO survival rates are 35.7% for our included patients. Nonsurvivors had much higher rates of receiving CRRT (64.4% vs 20.0%, p < 0.001) and higher initial (22 vs 18, p = 0.030) and average (31 vs 21, p = .023) BUN values than the survivors. Non survivors also received much more pRBCs (3451 vs 2080 ml, p = 0.003), platelets (1900 vs 556 ml, p = 0.003) and FFP (1123 vs 240 ml, p = .001) over the course of their run than survivors. There was no significant difference in any measured platelet counts between patients. Conclusions Patients that receive increased blood product administration and reduced kidney function during VA ECMO are at an increased risk of mortality. Further studies are required to further elucidate markers of ECMO outcomes that can guide the practice.