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Age and associated outcomes among patients receiving venoarterial extracorporeal membrane oxygenation–analysis of the Extracorporeal Life Support Organization registry

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Abstract

Purpose

Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO.

Methods

We used individual-level patient data from 440 centers in the international Extracorporeal Life Support Organization registry. We included all adult patients receiving V-A ECMO from 2017 to 2019. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of V-A ECMO. We conducted Bayesian analyses of the relationship between increasing age and outcomes of interest.

Results

We included 15,172 patients receiving V-A ECMO. Of these, 8172 (53.9%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18–29, the age bracket of 30–39 (odds ratio [OR] 0.94, 95% credible interval [CrI] 0.79–1.10) was not associated with hospital mortality, but age brackets 40–49 (odds ratio [OR] 1.26, 95% CrI: 1.08–1.47), 50–59 (OR 1.78, 95% CrI: 1.55–2.06), 60–69 (OR 2.24, 95% CrI: 1.94–2.59), 70–79 (OR 2.90, 95% CrI: 2.49–3.39) and ≥ 80 (OR 4.02, 95% CrI: 3.13–5.20) were independently associated with increasing hospital mortality. Similar results were found in the analysis conducted with an informative prior, as well as between increasing age and post-ECMO complications.

Conclusions

Among patients receiving V-A ECMO for cardiogenic shock, increasing age is strongly associated with increasing odds of death and complications, and this association emerges as early as 40 years of age.

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Funding

Authors did not received any funding for this work.

Author information

Author notes

  1. Shannon M. Fernando and Graeme MacLaren contributed equally as co-first authors. Daniel Brodie and Daniel I. McIsaac contributed equally as co-senior authors.

Authors and Affiliations

  1. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Shannon M. Fernando & Daniel I. McIsaac

  2. Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada

    Shannon M. Fernando

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Graeme MacLaren & Kollengode Ramanathan

  4. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore

    Graeme MacLaren & Kollengode Ramanathan

  5. Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA

    Ryan P. Barbaro

  6. Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA

    Ryan P. Barbaro

  7. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Rebecca Mathew

  8. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Laveena Munshi

  9. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Laveena Munshi

  10. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Purnema Madahar

  11. Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA

    Purnema Madahar

  12. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Justin A. Fried

  13. Department of Cardio Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands

    Roberto Lorusso

  14. Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands

    Roberto Lorusso

  15. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Daniel Brodie

  16. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac

  17. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac

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  1. Shannon M. Fernando
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Contributions

SMF, GM, DB, and DIM conceived the study idea. All authors participated in study design. DIM performed data analyses. All authors interpreted the data analyses. All authors co-wrote and revised the manuscript for intellectual content. All authors provided their final approval for manuscript submission. All authors agree to be accountable for all aspects of the work. SMF and GM are co-first authors. DB and DIM are co-senior authors.

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Correspondence to Shannon M. Fernando.

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Conflicts of interest

SMF has no conflicts to declare. GML is President of the Extracorporeal Life Support Organization (ELSO). RPB is the ELSO Registry Chair. RM has no conflicts to declare. LM has no conflicts to declare. PM has no conflicts to declare. JAF has no conflicts to declare. KR is Co-Chair of the ELSO Scientific Oversight Committee. RL is a consultant and conducts clinical trials for LivaNova. He receives research support from Medtronic, and serves as a consultant for Medtronic, Getinge, and Abiomed. He serves on the medical advisory boards of Fresenius, Hemocue, and Eurosets. DB receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. DIMcI receives salary support from The Ottawa Hospital Anesthesia Alternate Funds Association and holds a Research Chair from the University of Ottawa Faculty of Medicine.

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Fernando, S.M., MacLaren, G., Barbaro, R.P. et al. Age and associated outcomes among patients receiving venoarterial extracorporeal membrane oxygenation–analysis of the Extracorporeal Life Support Organization registry. Intensive Care Med 49, 1456–1466 (2023). https://doi.org/10.1007/s00134-023-07199-1

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