title: Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation.
abstract: For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO.
  
  
  
  We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015.
  
  
  
  A total of 195 patients were included in this registry with a medium age of 58.2 ± 1.1 years, 71.8% were male. A positive fluid balance was detected in 94.7% at day 1 (day 2: 93.7%, day 3: 92.6%). Consistently, survivors had a lower fluid balance when compared to non-survivors (P < .001). Three hours post-implantation, patients above the 75th percentile had a hazard ratio of 6.03 when compared to average survival (P < .05). AUC at that time point was 0.726 as calculated by ROC. Patients below the 50th percentile (fluid balance below 8500 mL after 24 hours) had the best prognosis after VA-ECMO implantation (P < .001).
  
  
  
  Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker.
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany. Electronic address: dawid.staudacher@universitaets-herzzentrum.de.
authors.forename: Dawid L
authors.initials: DL
authors.lastname: Staudacher
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gold
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Biever
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wengenmayer
mesh_terms: D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005440:Fluid Therapy; D005858:Germany; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012151:Resuscitation; D012189:Retrospective Studies; D014882:Water-Electrolyte Balance
keywords: Cardiopulmonary resuscitation; Critically Ill; Prognosis; Sepsis; Veno-arterial extracorporeal membrane oxygenation; Water-electrolyte balance