Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation

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Abstract

Purpose:

For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO.

Material and methods:

We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015.

Results:

A total of 195 patients were included in this registry with a medium age of 58.2 ± 1.1 years, 71.8% were male. A positive fluid balance was detected in 94.7% at day 1 (day 2: 93.7%, day 3: 92.6%). Consistently, survivors had a lower fluid balance when compared to non-survivors (P < .001). Three hours post-implantation, patients above the 75th percentile had a hazard ratio of 6.03 when compared to average survival (P < .05). AUC at that time point was 0.726 as calculated by ROC. Patients below the 50th percentile (fluid balance below 8500 mL after 24 hours) had the best prognosis after VA-ECMO implantation (P < .001).

Conclusions:

Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker.

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