title: Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.
abstract: Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care.
  
  
  
  Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007-2014).
  
  
  
  Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (<10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45yo vs 55yo, p=0.0001) and higher systolic blood pressure (115mmHg vs 103mmHg, p=0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p=0.0003), chloride (p=0.009), bicarbonate (p=0.015) and pH (p=0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02-1.13; p=0.004), pH (OR 3.35; 95% CI 1.89-5.9; p<0.0001) and aPTT (OR 0.98; 95% CI 0.976-0.998; p=0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06-3.34; p=0.029).
  
  
  
  Laboratory markers identified herein may guide the management of patients on ECMO.
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States. Electronic address: Ivfranci@montefiore.org.
authors.forename: Ivo M B
authors.initials: IMB
authors.lastname: Francischetti
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: James
authors.initials: J
authors.lastname: Szymanski
authors.affiliation: Pediatric Perfusion Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Lucia R
authors.initials: LR
authors.lastname: Wolgast
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy; D057286:Electronic Health Records; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: ECMO; Epidemiology; Retrospective study; Risk factors; Venous, arterial