Heart failure

Extracorporeal resuscitation for acute heart failure: predictors of mortality

In patients with acute heart failure treated with extracorporeal support (ECLS), in-hospital mortality is high; independent predictors of ECLS mortality include age, simplified acute physiology score (SAPS) II, new liver failure, and number of allogeneic blood transfusion units given per day. These are among the results of a 13-year single-center study recently published in Journal of Chest Disease.

The researchers sought to describe in-hospital mortality among patients who required ECLS, identify independent predictors related to mortality, and analyze changes in mortality rates over time. To this end, a retrospective, observational, single-center study was conducted at the University Hospital of Zurich in Switzerland – a tertiary care referral hospital and designated ECLS center – between January 2007 and December 2019. Only cases of disease Cardiovascular veno-arterial or cardiopulmonary support were considered for the study.

Indications for ECLS therapy have been grouped into 4 categories: (1) post-cardiotomy, (2) cardiopulmonary resuscitation, (3) refractory cardiogenic shock, and (4) other. The “post-cardiotomy group” included those with ECLS indications of intraoperative weaning failure due to cardiopulmonary bypass and postoperative refractory cardiogenic shock. Those in the “cardiopulmonary resuscitation group” included patients treated with ECLS during cardiac arrest or immediately after return of spontaneous circulation. The “other” category included people with ECLS indications for expansive thoracic surgery, including lung transplantation.


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During the 13-year study period, ECLS treatment was required in a total of 679 hospitalized patients. The average age of the patients was 60 years old; 27.5% of patients were women. In-hospital mortality was reported in 55.5% (377 of 679) of patients. This rate varied significantly between ECLS indications: 70.7% (152 of 215) of patients who underwent post-postiotomy; 67.9% (108 of 159) of people receiving cardiopulmonary resuscitation; 47.0% (110 of 234) of people in refractory cardiogenic shock; and 9.9% (7 of 71) among those undergoing lung transplantation or other extensive chest surgery (P <.001>

Cubic spline interpolation revealed no evidence of a change in mortality over the 13-year study period. Logistic regression modeling demonstrated excellent discrimination in the receiver operating characteristic (ROC) area under the curve (AUC) of 0.89 (95% CI, 0.87-0.92). This finding surprised the investigators, who said they had “expected a reduction in mortality over the years, due to knowledge gained and improved ECLS treatment”.

The investigators acknowledged that their study was limited by the fact that technological and process improvements had taken place over the 13-year study period, creating considerable bias.

According to the researchers, “knowledge of predictors strongly associated with in-hospital mortality may affect future decisions regarding ECLS indications and respective management to more effectively utilize this elaborate therapy.”

Disclosure: Some of the study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original citation for a full list of author disclosures.

Reference

Sahli SD, Kaserer A, Braun J, et al. Predictors associated with mortality from extracorporeal life-sustaining therapy for acute heart failure: single-center experience with 679 patients. J Thorac Dis. 2022;14(6):1960-1971. doi:10.21037/jtd-21-1770