In their work, the authors characterized the incidence and effect on outcomes of new-onset atrial arrhythmias in patients undergoing support with venovenous extracorporeal membrane oxygenation (VV ECMO) predominantly for infection-related acute respiratory distress syndrome. Of note, this study population was from the time period of January 1, 2016 to January 1, 2019, and, thus, the VV ECMO COVID-19 subgroup was not represented by this investigation. In their work, the authors found that of the 219 VV ECMO patients eligible for inclusion, 67 (30.5%) developed atrial arrhythmias of clinical significance (defined as requiring pharmacologic or electrical therapy). Important data, such as potassium and magnesium levels at the time of arrhythmia, history of pulmonary hypertension and cardiovascular disease (both more common in the arrhythmia group), age (atrial arrhythmia patients were older), and history of beta-blocker and calcium-channel blocker use, were recorded (more common in the arrhythmia group). Mortality was found to be 19.1% in the group without new-onset atrial arrhythmias and 38.8% in the group with new-onset clinically significant atrial arrhythmias. The high survival of the overall group (164 of 219 or 74.9%) is notable given the 59% survival to hospital discharge recorded by the Extracorporeal Life Support Organization international summary for adult patients supported by VV ECMO.
Of note, age, male sex, and the need for norepinephrine were the only risk factors for the development of atrial arrhythmias in this patient population when a multivariate logistic regression model was used to study the data.