Cardiac tamponade complicating extracorporeal membrane oxygenation: an Extracorporeal Life Support Organization Registry analysis.
Abstract
Objectives
Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, we assessed the incidence, patient characteristics, and risk factors for mortality of cardiac tamponade during ECMO.
Design
We queried the Extracorporeal Life Support Organization (ELSO) Registry from 1997 to 2021 for all adults with cardiac tamponade as a reported complication during ECMO.
Participants
Cardiac tamponade was reported in 2176 (64% men; 53.8±0.33 years) of 84430 adults (2.6%).
Measurements and Main Results
Venoarterial ECMO was the main configuration (78%) followed by venovenous ECMO (VV-ECMO; 18%), for cardiac (67%), pulmonary (21%) support, and extracorporeal cardiopulmonary resuscitation (ECPR; 12%). Percutaneous cannulation was performed in 51%, with the femoral vein and femoral artery as the most common sites for drainage and return cannulae, with dual lumen cannula in 39% of VV-ECMO. Hospital survival was lower (35% vs. 49%; p< .01) when compared with that of all adults from the ELSO Registry. In multivariable analysis, age, aortic dissection/rupture, COVID-19, ECPR, pre-ECMO renal replacement therapy, and prone position, are associated with hospital mortality, while ECMO for pulmonary support is associated with hospital survival. Similarly, renal, cardiovascular, metabolic, neurologic, and pulmonary complications occurred more frequently in non-survivors.
Conclusions
Cardiac tamponade is a rare complication during ECMO that despite being potentially reversible, is associated with high hospital mortality. VA-ECMO is the most common configuration. ECMO for pulmonary support was associated with higher survival and ECPR was associated with higher mortality. In these patients, other ECMO-related complications were frequently reported and associated with hospital mortality.