Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane oxygenation is predictive of death prior to hospital discharge, renal dysfunction requiring dialysis and pulmonary oedema.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are titrated to achieve adequate perfusion while attempting to ideally maintain arterial pulse pressure (PP). We assessed risk in patients with low PP defined as <10 mmHg within the first 2 days of support. Methods: Demographics, haemodynamics, echocardiographic and radiological findings were recorded retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital mortality, requirement for renal replacement therapy (RRT) and severe pulmonary oedema (PO). Results: Of 101 patients, 66.3% were male, mean age was 56 (range 18–71 years), mean duration of support was 6.3 days ± 4.1 days, 37.6% died prior to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO were (respectively): 0.69 (95% CI 0.58–0.80, p =.001), 0.64 (95% CI 0.50–0.77, p =.044), 0.69 (95% CI 0.55–0.82, p =.009). The odds ratio for mortality, RRT, severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01–7.5, p =.04), 3.1 (95% CI 1.11–8.40, p =.026), 7.6 (95% CI 2.06–27.89, p =.001). Central venous pressure, mean arterial pressure were not predictive. Conclusion: PP during the first 2 days of support is predictive of clinically important outcomes in patients supported with VA-ECMO. [ABSTRACT FROM AUTHOR]