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Review
Table B
Breakdown of significant pre-VA-ECMO patient factors with associated indications and study details.
| Significant pre-ECMO patient factor | Associated VA ECMO indication | Statistical information by study | Study sample size | Study type |
|---|---|---|---|---|
| Presence of initial shockable rhythm | In-hospital cardiac arrest [28, 29] | – 49.5% vs. 37.2%, OR 1.65, 95% CI: 1.05–2.61; p = 0.03 | N = 856 | Systematic review and meta-analysis |
| – 53.3% vs. 24.3%, p < 0.01 | N = 137 | Single-center retrospective cohort study | ||
| Shorter low-flow time (arrest to ECMO time) | In-hospital cardiac arrest [28, 29] | – 28.7 ± 4.1 vs. 46.1 ± 5.1 min, p < 0.00001 | N = 856 | Systematic review and meta-analysis |
| – 30 (25–53) vs.50 (35–80) min, p < 0.01 | N = 137 | Single-center retrospective cohort study | ||
| STEMI with CS [38] | – Arrest to ECMO time: OR: 1.63, 95% CI: 1.00–2.66 | N = 1162 | Systematic review and meta-analysis | |
| – CPR time: OR: 1.85, 95% CI: 1.21–2.83 | ||||
| Lower pre-ECMO lactate | In-hospital cardiac arrest [29] | – 6.9 ± 0.8 vs. 11.0 ± 0.50 mmol/L, p < 0.0001 | N = 856 | Systematic review and meta-analysis |
| Postcardiotomy shock [30] | – OR per unit: 1.22, 95% CI: 1.07–1.40, p = 0.004 | N = 107 | Single-center retrospective cohort study | |
| Postcardiotomy shock >70 yrs [31] | – Pre-ECMO lactate >6 mmol/L (82.6% vs. 70.4%, p = 0.029) | N = 781 | Systematic review and meta-analysis | |
| Postcardiotomy shock [34] | – Lactate 9.3 mmol/L in non-survivors vs. 6.6 mmol/L in survivors, p < 0.0001 | N = 1269 | Individual patient data meta-analysis | |
| Postcardiotomy shock [35] | – Initial level > 6.25 mmol/L AUROC: 0.731, OR: 1.21, 95% CI: 1.016–1.721, p = 0.032 | N = 152 | Retrospective single-center study | |
| STEMI with CS [38] | – Lactate >8 mmol/L: OR: 2.90, 95% CI: 0.36–23.61 | N = 1162 | Systematic review and meta-analysis | |
| Pre-ECMO acidosis | Calcium channel blocker toxicity [36] | – pH ≥ 7.1 vs. pH < 7.1: OR: 3.87, 95% CI: 1.15–12.99, p = 0.028 | N = 98 | Retrospective ELSO registry analysis |
| Lower SOFA score at ECMO initiation | In-hospital cardiac arrest [29] | – PMD −1.71 [−2.93, −0.50], p = 0.006 | N = 856 | Systematic review and meta-analysis |
| Postcardiotomy shock [35] | – 13.5 vs. 9, p < 0.001 | N = 152 | Retrospective single-center study | |
| Lower pre-ECMO creatinine | In-hospital cardiac arrest [29] | – 1.11 ± 0.05 vs. 1.48 ± 0.06 mg/dL, p = 0.003 | N = 856 | Systematic review and meta-analysis |
| Postcardiotomy shock [33] | – Survivors: 79.6–128 (avg. 98.1) vs non-survivors: 80–148.5 (avg. 105.6), p = 0.003 | N = 2058 | Retrospective international multi-center study | |
| Postcardiotomy shock [35] | – CKD: 26.9 vs. 6.3%, p = 0.004 | N = 152 | Retrospective single-center study | |
| Pre-ECLS renal replacement therapy | Calcium channel blocker toxicity [36] | – OR: 10.08, 95% CI: 1.95–52.00, p = 0.006 | N = 98 | Retrospective ELSO registry analysis |
| Liver disease | All VA ECMO indications [37] | – Chronic liver disease: OR: 8.87, p = 0.04 – Elevated total bilirubin: OR: 1.093, p < 0.0001 |
N = 789 | Registry for CS: utility and efficacy of device therapy retrospective analysis |
| Subsequent cardiovascular intervention (surgery or PCI) | In-hospital cardiac arrest [28] | – 63.3% vs. 26.2%, p < 0.01 | N = 137 | Single-center retrospective cohort study |
| BMI | STEMI with CS [38] | – BMI >25 kg/m2: OR: 3.98, 95% CI: 0.92–17.25 | N = 1162 | Systematic review and meta-analysis |
| Older age | In-hospital cardiac arrest [28] | – Age ≥ 55 years, multivariable OR: 4.8 95% CI: [1.7–15.4], p = 0.005 | N = 137 | Single-center retrospective cohort study |
| Postcardiotomy shock >70 yrs [31] | – Age > 70 years (76.1% vs. 58.7%, adjusted OR: 2.199, 95% CI: 1.536–3.149) | N = 781 | Systematic review and meta-analysis | |
| Postcardiotomy shock [33] | – Non-survivors average age 67 (58–73) vs. survivors average age 61.75 (52.2–70), p < 0.001 | N = 2058 | Retrospective international multi-center study | |
| Cardiogenic shock [32] | – 40–49 (OR: 1.26, [95% CI:1.08–1.47]) – 50–59 (OR:1.78, [95% CI: 1.55–2.06]) – 60–69 (OR: 2.24 [95% CI: 1.94–2.59]) – 70–79 (OR: 2.90 [95% CI: 3.13–5.20]) – OR: 1.019, p = 0.007 |
N = 15,172 | ELSO registry retrospective analysis | |
| All VA ECMO indications [37] | – Age > 65 years: OR: 2.50, 95% CI: 1.48–4.24 | N = 789 | Registry for CS: utility and efficacy of device therapy retrospective analysis | |
| STEMI with CS [38] | – Per year of age: OR: | N = 1162 | Systematic review and meta-analysis | |
| Early graft dysfunction post heart transplant [40] | – 1.02, 95% CI: 1.01–1.04 | N = 1477 | Systematic review and meta-analysis | |
| Other mechanical support | In-hospital cardiac arrest [28] | – Univariable OR: 0.3 95%CI: [0.1–0.9], p = 0.03 | N = 137 | Single-center retrospective cohort study |
| Ischemic heart disease | Postcardiotomy shock [30] | – OR: 7.87, 95% CI: 2.55–24.3, p < 0.001 | N = 105 | Single-center retrospective cohort study |
| STEMI with CS [38] | – Anterior wall infarction: OR: 1.69, 95% CI: 1.37–2.07 | N = 1162 | Systematic review and meta-analysis | |
| Pre-operative cardiac arrest | Postcardiotomy shock [33] | – HR: 1.34, 95% CI: 1.08–1.66, p = 0.0073 | N = 2058 | Retrospective international multi-center study |
| Pre-ECLS cardiac arrest | All VA ECMO indications [37] | – OR: 2.76, p = 0.006 | N = 789 | Registry for CS: utility and efficacy of device therapy retrospective analysis |
| All VA ECMO indications [39] | – OR: 3.67, 95% CI: 1.66–8.31, p < 0.01 | N = 177 | Retrospective single-center study | |
| Pre-operative cardiogenic shock | Postcardiotomy shock [33] | – 17.9% in survivors vs. 23.6% in non-survivors, p = 0.002 | N = 2058 | Retrospective international multi-center study |
| Pre-operative septic shock | Postcardiotomy shock [33] | – 1.3% in survivors vs. 3.3% in non-survivors, p = 0.005 | N = 2058 | Retrospective international multi-center study |
| Pre-operative cardiac diagnosis | Postcardiotomy shock [33] | – Aortic vessel disease: 13.4% in survivors vs. 18.2% in non-survivors, p = 0.003 – Aortic valve disease: 27.8% in survivors vs. 38.2% in non-survivors, p < 0.001 – Tricuspid valve disease: 13.9% in survivors vs. 17.4% in non-survivors, p = 0.032 |
N = 2058 | Retrospective international multi-center study |
| Atrial fibrillation | Postcardiotomy shock [35] | – Non-survivors 41.35% vs. 12.5% in survivors, p < 0.001 | N = 152 | Retrospective single-center study |
| Prolonged CPB time | Postcardiotomy shock [35] | – 237 min vs. 192 min, p = 0.016 | N = 152 | Retrospective single-center study |
| Aortic cross-clamp times | Postcardiotomy shock [35] | – 160 vs. 124 min, p = 0.04 | N = 152 | Retrospective single-center study |
| Prior sternotomy | Early graft dysfunction post heart transplant [40] | – OR: 1.57, 95% CI: 0.99–2.49 | N = 1477 | Systematic review and meta-analysis |
| Older donor age | Early graft dysfunction post heart transplant [40] | – OR: 1.01, 95% CI: 1.00–1.03 | N = 1477 | Systematic review and meta-analysis |
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