A greater likelihood of worse outcomes and a higher risk of mortality exists following an extracorporeal membrane oxygenation (ECMO) operation for patients with comorbid obstructive sleep apnea (OSA) or hepatic failure, according to research presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held October 16 to 19, in Nashville, Tennessee.
Researchers sought to predict poor outcomes in patients following ECMO by evaluating the association between patient comorbidities and in-hospital death.
They conducted a retrospective study using 2019 data from the inpatient national sample that included 11,295 adult patients treated with ECMO. The study group (35.6% women; 63.3% White; mean age, 53.57 years) had an in-hospital mortality rate of 41.5% (mean stay, 22.8 days; mean hospital cost, $836,947).
Researchers found that patients who died in-hospital following ECMO vs those discharged following ECMO had higher percentages of congestive heart failure (56.1% vs 46.9%; P =.0001), hepatic failure (acute/chronic) (41.7% vs 19.2%; P <.001), chronic kidney disease (21.5% vs 17.4%; P =.01), and cerebral vascular accident history (9.2% vs 5.8%; P =.001).
Weighted analysis revealed higher adjusted odds ratios (aORs) for mortality in patients with a hepatic failure (acute/chronic) secondary diagnosis (aOR, 2.8; 95% CI, 2.25-3.50; P <.001) compared with patients without hepatic failure or OSA secondary diagnosis (aOR, 1.53; 95% CI, 1.15-2.06; P =.004) and compared with patients without OSA. The researchers also found lower odds for mortality in patients with home oxygen dependence vs patients without home oxygen dependence (aOR, 0.58; 95% CI, 0.36-0.94; P =.02).
“Patients with OSA and patients with hepatic failure had considerably worse outcomes and had a higher risk of mortality following an ECMO operation,” the researchers wrote. They added that patients with home oxygen dependence prior to the ECMO procedure had a decreased risk of death. They urged clinicians choosing patients for invasive procedures including ECMO to consider these comorbidities.
Al-Khateeb M, Aldiabat M, Ghanem F, Horoub A, Heraud SO, Al Jabiri Y. Insight into extracorporeal membrane oxygenation (ECMO) hospitalization predictors of mortality and patient characteristics: 11,295 ECMO runs. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.