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A Longitudinal Analysis of NT-proBNP After LVAD Implantation
S346
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
hemodynamic changes and small changes in driveline phase conditions. These conditions can be evaluated through log files stored in VAD controllers. Methods: Log files were downloaded from 42 HMII patients and 51 HVAD patients during hospital stays and in outpatient clinic. Log file viewers were created using Microsoft Excel with Visual Basic (Microsoft Corporation). HMII controller data included: flow, speed, power, pulsatility index, voltage, driveline phase data, and triggered alarms. HVAD data included: motor current, voltage, speed, power, flow, pulsatility, battery status, triggered alarms, and event data. Log file retrospective analysis was performed. Results: Review of log files revealed short-term and long-term changes in patient hemodynamics and VAD status. In two HVAD patients, a 40% drop in pulsatility was seen over 3-4 months (Figure 1A), which corresponded to a drop in flow, prompting evaluation of outflow graft obstruction. Sixteen HMII patients demonstrated a pronounced difference in current between motor phases (Figure 1B); two ungrounded patient cables were issued: one as a precaution and one to prevent VAD stops.
Table 1: VA ECMO outcomes
TOTAL LV RV CCU CTS/ANS Cardiac arrest AMI HF PE RVF PCS
Number of patients survived Overall ECMO
Percent of patients survived ECMO
Number of patients survived to discharge
Percent of patients survived to discharge
Percent of ECMO survivors who were discharged
167 109 49 75 84 43
83 54 26 41 37 17
49.7 49.5 53.1 54.7 44 39.5
63 37 23 32 26 12
37.7 33.9 46.9 42.7 30.9 27.9
75.9 68.5 88.5 78 70.3 70.6
18 36 19 18 24
10 24 12 8 7
55.5 66.6 63.1 44.4 29.2
6 18 11 6 5
33.3 50 57.8 33.3 20.8
60 75 91.7 75 71.4
1( 059) Acute Hemodynamic Effects of Cardiac Resynchronization Therapy in Patients with Left Ventricular Assist Device J.M. Joly , E. Andrikopoulou, C.P. Lin, D. Acharya, S.V. Pamboukian, S.D. Prabhu, I.N. Rajapreyar, J.A. Tallaj, V. Kumar. University of Alabama at Birmingham, Birmingham, AL.
Conclusion: The aforementioned patient care tool may serve as a predictor of hemodynamic changes and pump malfunction. Ideally, future controllers should have higher storage capacity, thus, reducing gaps in log file data. 1( 058) Outcomes of Veno Arterial Extracorporeal Membrane Oxygenation at University of Kentucky Based on Etiology of Cardiogenic Shock A.R. Kolodziej , A. Burchett, T.A. Tribble, R. Charnigo, S. Smyth, M. Guglin. Cardiology, University of Kentucky, Lexington, KY. Purpose: To evaluate Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) outcomes based on etiology of cariogenic shock. Methods: We retrospectively reviewed the records of patients who received VA ECMO at our institution over a four-year period. Our primary outcome was survival to hospital discharge. Fisher’s exact test was used for statistical analysis. Results: Between January 1, 2012, and May 1, 2016, VA ECMO was initiated to provide support for cardiogenic shock in 155 patients on 167 occurrences. Overall survival to hospital discharge was 37.7%. There was no significant difference in survival between central and peripheral cannulation, between primarily left ventricular or right ventricular origin of cardiogenic shock, or depending on the team providing cannulation and treatment. We grouped the indications for VA ECMO in the following categories: cardiac arrest, acute myocardial infarction (AMI), acute heart failure (HF), pulmonary embolism (PE), right ventricular failure due to other pulmonary conditions (RVF), and postcardiotomy syndrome (PCS). The outcomes are shown in Table 1. Postcardiotomy syndrome resulted in lowest survival to discharge of 20.8%. In comparison survival to discharge in pulmonary embolism and heart failure were much better with p-values being 0.01 and 0.02 respectively. Conclusion: In our experience, patients treated with VA ECMO for cardiogenic shock had the lowest survival to discharge if the indication was postcardiotomy syndrome. Survival was significantly better in cardiogenic shock due to heart failure (50%) or pulmonary embolism (57.8%). Out of patients who were decannulated off ECMO alive, best survival to discharge was in the pulmonary embolism group at 91.7%. Heart failure and pulmonary embolism demonstrate most favorable outcomes out of all etiologies of cardiogenic shock.
Purpose: Cardiac resynchronization therapy (CRT) improves hemodynamics and long term outcomes in appropriately selected heart failure patients. Some have progressive symptoms despite CRT, and may require durable mechanical circulatory support. CRT management after left ventricular assist device (LVAD) has not been well studied. We sought to determine whether CRT measurably impacts the acute hemodynamic profile in patients with continuous flow LVAD. Methods: We identified 18 patients with CRT and LVAD followed at our institution. Over a four month period, six underwent right heart catheterization (RHC). One patient was excluded at the time of RHC because pacing caused diaphragmatic stimulation. Invasive assessment of cardiac filling pressures and oximetry was obtained during right ventricular pacing, biventricular pacing, and when able, during intrinsic conduction. We waited five minutes after each pacing mode change before acquiring hemodynamic data. A paired t-test was used to evaluate changes with different pacing modes. Results: There was no significant difference in right atrial pressure, mean pulmonary artery pressure, capillary wedge pressure, cardiac index, nor any LVAD parameter with CRT on vs. off (Table). Conclusion: CRT has no acute hemodynamic benefit in patients with LVAD. Diaphragmatic stimulation, inflow cannula obstruction, arrhythmia, and high threshold may warrant deactivating the coronary sinus lead. Our study shows this can be done safely without adversely affecting hemodynamics. Routine deactivation of the coronary sinus lead after LVAD could also significantly prolong battery life of the ICD. Longitudinal studies are needed to evaluate the potential remodeling benefit of CRT over time in this patient population.
1( 060) A Longitudinal Analysis of NT-proBNP After LVAD Implantation C. Falls , G. Lolay, K. Kido, B. George, H. Omar, M. Guglin. University of Kentucky, Lexington, KY. Purpose: N-terminal proBNP peptide (NT-proBNP) is a well-validated biomarker for diagnosis in heart failure. While few studies have examined BNP after LVAD implant, little is known about NT-proBNP. Our purpose was to compare longitudinal trends in NT-proBNP concentration after LVAD implant.
Abstracts S347 Methods: We retrospectively analyzed patients who had LVAD implantation at the University of Kentucky between 2010 and 2016. We did a comparative analysis of NT-proBNP at 1 week, 1 month, 3 month, 6 month, 1 year, 2 year with baseline (before LVAD implantation) using paired student’s t-test. We also calculated the number of patients with abnormal NT-proBNP up to 2 years after LVAD implantation. Potential determinants, especially echocardiographic variable were analyzed for correlation. Results: We identified and analyzed 82 patients for this study. NT-proBNP started decreasing after 1 month of LVAD implantation and continued to decline until 2 years post-LVAD implantation. This decrease reached statistical significance at 3 months and remained significant throughout 2 years. Despite this, a large proportion (35%) after LVAD implantation remained with elevated NT-proBNP up to 2 years after LVAD implantation (see table). At 1 month and 3 month, NT-proBNP correlated with LVEDD. Conclusion: NT-proBNP decreases significantly after LVAD implantation but remains elevated in about 1/3 of patients up to 2 years post LVAD implantation. More research is needed to better understand the determinants of NT-proBNP elevation after LVAD implantation.
Table 1: Descriptive Statistics of NT-proBNP NT-proBNP
Baseline 1 week 1 month 3 month 6 month 1 year 2 year
Mean 2660.6 Std. 1658.8 deviation P for comparison to baseline Proportion 65% of patients with elevated NT-proBNP
2473.5 2049.2 1100.8 907.2
1382.3 827.3
1158.9 1124.9
986.6 941.9
828.4 655.0
0.77
0.2
0.004
0.015
0.027
0.05
88%
88%
56%
44%
37%
34%
1( 061) Configuration of Extracorporeal Circulation and Association with Outcomes R.A. Rose ,1 V. Kagan,2 R.M. Piech,2 A.F. Linden,3 N. Uriel,4 V. Jeevanandam,2 T.H. Song.2 1ECMO/MCS Services, University of Chicago Medicine, Chicago, IL; 2Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL; 3Pediatric Surgery, University of Chicago Medicine, Chicago, IL; 4Cardiology, University of Chicago Medicine, Chicago, IL. Purpose: Extracorporeal Life Support (ECLS) has become widely used in rescuing patients suffering from cardiogenic shock and can be provided in various configurations. The configuration of ECLS may be a factor impacting survival. Methods: A retrospective chart review was performed on patients with cardiogenic shock who received ECLS between January and October of 2016. These patients were divided into two groups: those who received biventricular support with dual pump extracorporeal configuration and/or converted to this configuration within the first 48 hours of support (group A), and those supported by Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) with a single pump extracorporeal configuration or converted to biventricular support after 48 hours (group B). Patient attributes and survival outcomes were assessed. Results: 21 patients with cardiogenic shock were placed on ECLS during the time period reviewed. Group A consisted of 6 patients. 3 patients were placed on ECLS with biventricular support using dual pump extracorporeal configuration, and 3 patients were converted to this configuration within the first 48 hours of support. This group had an 83% success rate of ECLS liberation and 67% survival. Group B consisted of 15 patients. 15 patients were placed on ECLS with VA ECMO using a single pump extracorporeal configuration. 2 of these patients were converted to biventricular support after 48 hours. Group B had a 47% success rate of ECLS liberation and 26% survival. Conclusion: Patients with cardiogenic shock who received biventricular support, or were converted to this configuration within 48 hours had less favorable characteristics for improved outcomes including longer ECLS runs,
lower ejection fractions, and occurrence of central cannulation. Despite this, these patients had an improved success rate of ECLS liberation and survival to discharge. When feasible, early conversion to biventricular support may have a positive impact on successful liberation of pump and survival.
1( 062) Lactic Acid Is the Most Important Factor Predicting Survival on VA ECMO A. Kolodziej ,1 A. Burchett,1 T. Tribble,1 A.Y. Grigorian,2 M. Guglin.1 1Cardiology, University of Kentucky, Lexington, KY; 2Gastroenterology, University of Kentucky, Lexington, KY. Purpose: To evaluate common biomarkers associated with Veno- Arterial extracorporal membrane oxygenation outcomes. Methods: We retrospectively reviewed the records of patients who received the ECMO treatment of cardiogenic shock at our institution over a fouryear period. We have divided the groups based on etiology of cardiogenic shock requiring ECMO cannulation. Those included cardiac arrest, acute myocardial infarction (AMI), heart failure (HF), pulmonary embolism (PE) and postcardiotomy syndrome (PCS). Subsequently we evaluated laboratory parameters in survivors and non-survivors prior to ECMO cannulation, and then on the first and fifth day of support. Student’s t- test was used for statistical analysis. Results: Between January 1, 2012 and May 1, 2016, VA ECMO was initiated to provide support for cardiogenic shock in 155 patients on 167 occurrences. Overall survival to hospital discharge was 37.7%. Lactic acid appeared to be the only indicator which was consistently associated with poor outcomes (see the Table). The difference between lactic acid levels in survivors and non-survivors appeared to be greater on the first day of ECMO support than before cannulation. Conclusion: Of all the common laboratory biomarkers, lactic acid is the only strong metabolic predictor of survival. Lactate on day one on ECMO was a better predictor of survival than prior to ECMO, especially in AMI and postcardiotomy syndrome. Patients presenting with cardiogenic shock associated with high lactic acid should be carefully evaluated prior to cannulation with the ECMO circuit in terms of balancing risks and benefits.
Table 1: Lactic acid as indicator of poor outcomes in VA ECMO
Lactate (mean ± SD)
Cardiac arrest
AMI
HF
PE
PCS
Survived to discharge
Deceased
P-value
Baseline
6.123 ± 5.3
8.49 ± 7.0
0.019
Day 1 on ECMO Day 5 on ECMO Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5
2.4 ± 2.46 1.267 ± 0.6 6.7 ± 5.5 4.17 ± 4.6 1.2 ± 0.47 3.9 ± 2.28 1.14 ± 0.44 0.8 ± 0.14 4.8 ± 4.1 1.95 ± 1.16 1.15 ± 0.64 4.48 ± 4.3 9.0 ± 1.8 1.4 ± 0.6 9.7 ± 6.97 1.98 ± 0.5 1.3 ± 0.56
5.7 ± 5.8 2.18 ± 1.6 10.6 ± 6.73 7.4 ± 6.5 3.0 ± 2.4 7.4 ± 8.8 2.7 ± 1.8 1.47 ± 0.49 5.4 ± 5.7 3.9 ± 4.7 1.6 ± 0.94 9.3 ± 6.1 8.0 ± 4.74 3.05 ± 0.35 10.9 ± 7.2 7.75 ± 7.5 2.7 ± 2.45
< 0.0001 0.01 0.06 0.13 0.17 0.3 0.03 0.07 0.7 0.15 0.3 0.08 0.14 0.03 0.7 0.006 0.3
1( 063) Biventricular Pacing Has No Acute Hemodynamic Benefit Over Right Ventricular Pacing or Intrinsic Rhythm in LVAD Patients
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
hemodynamic changes and small changes in driveline phase conditions. These conditions can be evaluated through log files stored in VAD controllers. Methods: Log files were downloaded from 42 HMII patients and 51 HVAD patients during hospital stays and in outpatient clinic. Log file viewers were created using Microsoft Excel with Visual Basic (Microsoft Corporation). HMII controller data included: flow, speed, power, pulsatility index, voltage, driveline phase data, and triggered alarms. HVAD data included: motor current, voltage, speed, power, flow, pulsatility, battery status, triggered alarms, and event data. Log file retrospective analysis was performed. Results: Review of log files revealed short-term and long-term changes in patient hemodynamics and VAD status. In two HVAD patients, a 40% drop in pulsatility was seen over 3-4 months (Figure 1A), which corresponded to a drop in flow, prompting evaluation of outflow graft obstruction. Sixteen HMII patients demonstrated a pronounced difference in current between motor phases (Figure 1B); two ungrounded patient cables were issued: one as a precaution and one to prevent VAD stops.
Table 1: VA ECMO outcomes
TOTAL LV RV CCU CTS/ANS Cardiac arrest AMI HF PE RVF PCS
Number of patients survived Overall ECMO
Percent of patients survived ECMO
Number of patients survived to discharge
Percent of patients survived to discharge
Percent of ECMO survivors who were discharged
167 109 49 75 84 43
83 54 26 41 37 17
49.7 49.5 53.1 54.7 44 39.5
63 37 23 32 26 12
37.7 33.9 46.9 42.7 30.9 27.9
75.9 68.5 88.5 78 70.3 70.6
18 36 19 18 24
10 24 12 8 7
55.5 66.6 63.1 44.4 29.2
6 18 11 6 5
33.3 50 57.8 33.3 20.8
60 75 91.7 75 71.4
1( 059) Acute Hemodynamic Effects of Cardiac Resynchronization Therapy in Patients with Left Ventricular Assist Device J.M. Joly , E. Andrikopoulou, C.P. Lin, D. Acharya, S.V. Pamboukian, S.D. Prabhu, I.N. Rajapreyar, J.A. Tallaj, V. Kumar. University of Alabama at Birmingham, Birmingham, AL.
Conclusion: The aforementioned patient care tool may serve as a predictor of hemodynamic changes and pump malfunction. Ideally, future controllers should have higher storage capacity, thus, reducing gaps in log file data. 1( 058) Outcomes of Veno Arterial Extracorporeal Membrane Oxygenation at University of Kentucky Based on Etiology of Cardiogenic Shock A.R. Kolodziej , A. Burchett, T.A. Tribble, R. Charnigo, S. Smyth, M. Guglin. Cardiology, University of Kentucky, Lexington, KY. Purpose: To evaluate Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) outcomes based on etiology of cariogenic shock. Methods: We retrospectively reviewed the records of patients who received VA ECMO at our institution over a four-year period. Our primary outcome was survival to hospital discharge. Fisher’s exact test was used for statistical analysis. Results: Between January 1, 2012, and May 1, 2016, VA ECMO was initiated to provide support for cardiogenic shock in 155 patients on 167 occurrences. Overall survival to hospital discharge was 37.7%. There was no significant difference in survival between central and peripheral cannulation, between primarily left ventricular or right ventricular origin of cardiogenic shock, or depending on the team providing cannulation and treatment. We grouped the indications for VA ECMO in the following categories: cardiac arrest, acute myocardial infarction (AMI), acute heart failure (HF), pulmonary embolism (PE), right ventricular failure due to other pulmonary conditions (RVF), and postcardiotomy syndrome (PCS). The outcomes are shown in Table 1. Postcardiotomy syndrome resulted in lowest survival to discharge of 20.8%. In comparison survival to discharge in pulmonary embolism and heart failure were much better with p-values being 0.01 and 0.02 respectively. Conclusion: In our experience, patients treated with VA ECMO for cardiogenic shock had the lowest survival to discharge if the indication was postcardiotomy syndrome. Survival was significantly better in cardiogenic shock due to heart failure (50%) or pulmonary embolism (57.8%). Out of patients who were decannulated off ECMO alive, best survival to discharge was in the pulmonary embolism group at 91.7%. Heart failure and pulmonary embolism demonstrate most favorable outcomes out of all etiologies of cardiogenic shock.
Purpose: Cardiac resynchronization therapy (CRT) improves hemodynamics and long term outcomes in appropriately selected heart failure patients. Some have progressive symptoms despite CRT, and may require durable mechanical circulatory support. CRT management after left ventricular assist device (LVAD) has not been well studied. We sought to determine whether CRT measurably impacts the acute hemodynamic profile in patients with continuous flow LVAD. Methods: We identified 18 patients with CRT and LVAD followed at our institution. Over a four month period, six underwent right heart catheterization (RHC). One patient was excluded at the time of RHC because pacing caused diaphragmatic stimulation. Invasive assessment of cardiac filling pressures and oximetry was obtained during right ventricular pacing, biventricular pacing, and when able, during intrinsic conduction. We waited five minutes after each pacing mode change before acquiring hemodynamic data. A paired t-test was used to evaluate changes with different pacing modes. Results: There was no significant difference in right atrial pressure, mean pulmonary artery pressure, capillary wedge pressure, cardiac index, nor any LVAD parameter with CRT on vs. off (Table). Conclusion: CRT has no acute hemodynamic benefit in patients with LVAD. Diaphragmatic stimulation, inflow cannula obstruction, arrhythmia, and high threshold may warrant deactivating the coronary sinus lead. Our study shows this can be done safely without adversely affecting hemodynamics. Routine deactivation of the coronary sinus lead after LVAD could also significantly prolong battery life of the ICD. Longitudinal studies are needed to evaluate the potential remodeling benefit of CRT over time in this patient population.
1( 060) A Longitudinal Analysis of NT-proBNP After LVAD Implantation C. Falls , G. Lolay, K. Kido, B. George, H. Omar, M. Guglin. University of Kentucky, Lexington, KY. Purpose: N-terminal proBNP peptide (NT-proBNP) is a well-validated biomarker for diagnosis in heart failure. While few studies have examined BNP after LVAD implant, little is known about NT-proBNP. Our purpose was to compare longitudinal trends in NT-proBNP concentration after LVAD implant.
Abstracts S347 Methods: We retrospectively analyzed patients who had LVAD implantation at the University of Kentucky between 2010 and 2016. We did a comparative analysis of NT-proBNP at 1 week, 1 month, 3 month, 6 month, 1 year, 2 year with baseline (before LVAD implantation) using paired student’s t-test. We also calculated the number of patients with abnormal NT-proBNP up to 2 years after LVAD implantation. Potential determinants, especially echocardiographic variable were analyzed for correlation. Results: We identified and analyzed 82 patients for this study. NT-proBNP started decreasing after 1 month of LVAD implantation and continued to decline until 2 years post-LVAD implantation. This decrease reached statistical significance at 3 months and remained significant throughout 2 years. Despite this, a large proportion (35%) after LVAD implantation remained with elevated NT-proBNP up to 2 years after LVAD implantation (see table). At 1 month and 3 month, NT-proBNP correlated with LVEDD. Conclusion: NT-proBNP decreases significantly after LVAD implantation but remains elevated in about 1/3 of patients up to 2 years post LVAD implantation. More research is needed to better understand the determinants of NT-proBNP elevation after LVAD implantation.
Table 1: Descriptive Statistics of NT-proBNP NT-proBNP
Baseline 1 week 1 month 3 month 6 month 1 year 2 year
Mean 2660.6 Std. 1658.8 deviation P for comparison to baseline Proportion 65% of patients with elevated NT-proBNP
2473.5 2049.2 1100.8 907.2
1382.3 827.3
1158.9 1124.9
986.6 941.9
828.4 655.0
0.77
0.2
0.004
0.015
0.027
0.05
88%
88%
56%
44%
37%
34%
1( 061) Configuration of Extracorporeal Circulation and Association with Outcomes R.A. Rose ,1 V. Kagan,2 R.M. Piech,2 A.F. Linden,3 N. Uriel,4 V. Jeevanandam,2 T.H. Song.2 1ECMO/MCS Services, University of Chicago Medicine, Chicago, IL; 2Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL; 3Pediatric Surgery, University of Chicago Medicine, Chicago, IL; 4Cardiology, University of Chicago Medicine, Chicago, IL. Purpose: Extracorporeal Life Support (ECLS) has become widely used in rescuing patients suffering from cardiogenic shock and can be provided in various configurations. The configuration of ECLS may be a factor impacting survival. Methods: A retrospective chart review was performed on patients with cardiogenic shock who received ECLS between January and October of 2016. These patients were divided into two groups: those who received biventricular support with dual pump extracorporeal configuration and/or converted to this configuration within the first 48 hours of support (group A), and those supported by Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) with a single pump extracorporeal configuration or converted to biventricular support after 48 hours (group B). Patient attributes and survival outcomes were assessed. Results: 21 patients with cardiogenic shock were placed on ECLS during the time period reviewed. Group A consisted of 6 patients. 3 patients were placed on ECLS with biventricular support using dual pump extracorporeal configuration, and 3 patients were converted to this configuration within the first 48 hours of support. This group had an 83% success rate of ECLS liberation and 67% survival. Group B consisted of 15 patients. 15 patients were placed on ECLS with VA ECMO using a single pump extracorporeal configuration. 2 of these patients were converted to biventricular support after 48 hours. Group B had a 47% success rate of ECLS liberation and 26% survival. Conclusion: Patients with cardiogenic shock who received biventricular support, or were converted to this configuration within 48 hours had less favorable characteristics for improved outcomes including longer ECLS runs,
lower ejection fractions, and occurrence of central cannulation. Despite this, these patients had an improved success rate of ECLS liberation and survival to discharge. When feasible, early conversion to biventricular support may have a positive impact on successful liberation of pump and survival.
1( 062) Lactic Acid Is the Most Important Factor Predicting Survival on VA ECMO A. Kolodziej ,1 A. Burchett,1 T. Tribble,1 A.Y. Grigorian,2 M. Guglin.1 1Cardiology, University of Kentucky, Lexington, KY; 2Gastroenterology, University of Kentucky, Lexington, KY. Purpose: To evaluate common biomarkers associated with Veno- Arterial extracorporal membrane oxygenation outcomes. Methods: We retrospectively reviewed the records of patients who received the ECMO treatment of cardiogenic shock at our institution over a fouryear period. We have divided the groups based on etiology of cardiogenic shock requiring ECMO cannulation. Those included cardiac arrest, acute myocardial infarction (AMI), heart failure (HF), pulmonary embolism (PE) and postcardiotomy syndrome (PCS). Subsequently we evaluated laboratory parameters in survivors and non-survivors prior to ECMO cannulation, and then on the first and fifth day of support. Student’s t- test was used for statistical analysis. Results: Between January 1, 2012 and May 1, 2016, VA ECMO was initiated to provide support for cardiogenic shock in 155 patients on 167 occurrences. Overall survival to hospital discharge was 37.7%. Lactic acid appeared to be the only indicator which was consistently associated with poor outcomes (see the Table). The difference between lactic acid levels in survivors and non-survivors appeared to be greater on the first day of ECMO support than before cannulation. Conclusion: Of all the common laboratory biomarkers, lactic acid is the only strong metabolic predictor of survival. Lactate on day one on ECMO was a better predictor of survival than prior to ECMO, especially in AMI and postcardiotomy syndrome. Patients presenting with cardiogenic shock associated with high lactic acid should be carefully evaluated prior to cannulation with the ECMO circuit in terms of balancing risks and benefits.
Table 1: Lactic acid as indicator of poor outcomes in VA ECMO
Lactate (mean ± SD)
Cardiac arrest
AMI
HF
PE
PCS
Survived to discharge
Deceased
P-value
Baseline
6.123 ± 5.3
8.49 ± 7.0
0.019
Day 1 on ECMO Day 5 on ECMO Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5 Baseline Day 1 Day 5
2.4 ± 2.46 1.267 ± 0.6 6.7 ± 5.5 4.17 ± 4.6 1.2 ± 0.47 3.9 ± 2.28 1.14 ± 0.44 0.8 ± 0.14 4.8 ± 4.1 1.95 ± 1.16 1.15 ± 0.64 4.48 ± 4.3 9.0 ± 1.8 1.4 ± 0.6 9.7 ± 6.97 1.98 ± 0.5 1.3 ± 0.56
5.7 ± 5.8 2.18 ± 1.6 10.6 ± 6.73 7.4 ± 6.5 3.0 ± 2.4 7.4 ± 8.8 2.7 ± 1.8 1.47 ± 0.49 5.4 ± 5.7 3.9 ± 4.7 1.6 ± 0.94 9.3 ± 6.1 8.0 ± 4.74 3.05 ± 0.35 10.9 ± 7.2 7.75 ± 7.5 2.7 ± 2.45
< 0.0001 0.01 0.06 0.13 0.17 0.3 0.03 0.07 0.7 0.15 0.3 0.08 0.14 0.03 0.7 0.006 0.3
1( 063) Biventricular Pacing Has No Acute Hemodynamic Benefit Over Right Ventricular Pacing or Intrinsic Rhythm in LVAD Patients