Comparison of Extracorporeal Membrane Oxygenation Initiation in Cardiogenic Shock During Work-Hours Versus After-Hours
Abstract
Background
Extracorporeal membrane oxygenation (ECMO) as rescue therapy for cardiogenic shock (CS) is highly dependent on timeliness and medical resources.
Objectives
Aimed to assess ECMO management and outcomes in adult patients with CS in terms of on- and after-hour ECMO initiation from a national ECMO registry.
Methods
Adult patients diagnosed with CS and those who received ECMO were enrolled in the study. The population was divided into the work-hours and the after-hours group based on the time of ECMO initiation. In-hospital mortality and ECMO management were compared between them. Electronic data in this research were provided by Chinese Society of Extracorporeal Life Support.
Results
In a cohort of 1862 patients, 552 (29.6%) received ECMO during work-hours, whereas 1310 (70.4%) received ECMO during after-hours. After-hour ECMO had more patients with elective cardiac procedures (35.1% vs. 26.3%, p < 0.001) and higher severity (p < 0.001), with more patients with Society for Cardiovascular Angiography and Interventions shock stage D (29.6% vs. 24.5), E (60.0% vs. 51.8%), and fewer B (3.6% vs. 13.2%) and C (6.8% vs. 10.5%). A high proportion underwent intra-aortic balloon pump (IABP) implantation before ECMO (28.4% vs. 23.0%, p = 0.016) and mechanical ventilation (92.1% vs. 87.0%, p < 0.001) during after-hours. The in-hospital mortality in patients with after-hour ECMO initiation was higher than that in patients with work-hour ECMO initiation (51.8% vs. 45.3%, p = 0.011).
Conclusion
In this cohort, 70% were initiated during after-hours and showed higher in-hospital mortality than patients with work-hour ECMO initiation. After-hour ECMO initiation should be a concern for ECMO programs.