Hemocompatibility-Related Adverse Events and Survival on Venoarterial Extracorporeal Life Support: An ELSO Registry Analysis.

Objectives: This study sought to determine the frequency, incidence rates over time, association with mortality, and potential risk factors for hemocompatibility-related adverse events (HRAEs) occurring during venoarterial-extracorporeal life support (VA-ECLS).
Background: HRAEs are common complications of VA-ECLS. Studies examining relevant clinical predictors and the association of HRAEs with survival are limited by small sample size and single-center setting.
Methods: We queried adult patients supported with VA-ECLS from 2010 to 2017 in the Extracorporeal Life Support Organization database to assess the impact of HRAEs on in-hospital mortality.
Results: Among 11,984 adults meeting study inclusion, 8,457 HRAEs occurred; 62.1% were bleeding events. The HRAE rate decreased significantly over the study period (p trend <0.001), but rates of medical bleeding and ischemic stroke remained stable. HRAEs had a cumulative association with mortality in adjusted analysis: 1 event, odds ratio (OR) of 1.43; 2 events, OR of 1.86; ≥3 events, OR of 3.27 (p < 0.001 for all). HRAEs most strongly associated with mortality were medical bleeding, including intracranial (OR: 7.71), pulmonary (OR: 3.08), and gastrointestinal (OR: 1.95) hemorrhage and ischemic stroke (OR: 2.31); p < 0.001 for all. Risk factors included the following: for bleeding: older age, lower pH, and female sex; for thrombosis: younger age, male sex, Asian race, and non-polymethylpentene oxygenator; and for both: time on ECLS, central cannulation, and renal failure.
Conclusions: Although decreasing, HRAEs remain common during VA-ECLS and have a cumulative association with survival. Bleeding events are twice as common as thrombotic events, with a hierarchy of HRAEs influencing survival. Differential risk factors for bleeding and thrombotic complications exist and raise the possibility of a tailored approach to ECLS management.
Competing Interests: Author Relationship With Industry Dr. Chung is funded by the National Institutes of Health (T32-GM007592) as well as by Medtronic outside the submitted work. Drs. Cabezas and Grandin have received an Extracorporeal Life Support Organization Research Grant. Dr. Mehra has received consulting income from Abbott, Medtronic, Janssen, Bayer, Portola, FineHeart, NupulseCV, Leviticus, Mesoblast, and Triple Gene. Dr. Garan is an unpaid consultant to Abiomed. Dr. Kociol is employed by Boehringer Ingelheim. Dr. Grandin has received an Extracorporeal Life Support Organization Research Grant. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)