New-Onset Atrial Arrhythmias Are Independently Associated With In-Hospital Mortality in Veno-Venous Extracorporeal Membrane Oxygenation

Authors

Cecilia Li, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
Mehrnaz Pajoumand, Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
Kerry Lambert, Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
Laila Najia, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
Allison L. Bathula, Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
Michael A. Mazzeffi, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, The George Washington University Hospital, Washington, DC.
Samuel M. Galvagno, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
Ali Tabatabai, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
Alison Grazioli, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
Siamak Dahi, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Eric S. Hochberg, Department of Trauma Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, MD.
Michael E. Plazak, Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD. Electronic address: michael.plazak@umm.edu.

Document Type

Journal Article

Publication Date

6-1-2022

Journal

Journal of cardiothoracic and vascular anesthesia

Volume

36

Issue

6

DOI

10.1053/j.jvca.2021.12.012

Keywords

ECMO; arrhythmia; intensive care; mortality

Abstract

OBJECTIVE: To explore if atrial arrhythmias are associated with in-hospital mortality in veno-venous extracorporeal membrane oxygenation (VV-ECMO) patients. DESIGN: Retrospective observational cohort study. SETTING: Quaternary care academic medical center. PARTICIPANTS: Patients with respiratory failure requiring VV-ECMO for >24 hours between January 1, 2016, and January 1, 2019. INTERVENTIONS: None, observational study. MEASUREMENTS AND MAIN RESULTS: Two hundred nineteen VV-ECMO patients were included. Patients were stratified by absence or presence of clinically significant atrial arrhythmias during the VV-ECMO run. Atrial arrhythmias were defined as either atrial fibrillation or atrial flutter that occurred during VV-ECMO and required pharmacologic or electrical intervention. The primary outcome was in-hospital mortality. Secondary outcomes included a composite of thrombotic events, which included ischemic stroke and on-pump arterial thrombosis. Other objectives of this analysis included characterization of atrial arrhythmia incidence, risk factors, and management. A total of 67 patients (30.5%) experienced new-onset atrial arrhythmias post-ECMO cannulation. Age, male sex, and norepinephrine use were independently associated with atrial arrhythmia development. In-hospital mortality was significantly higher in the atrial arrhythmia group (38.8% v 19.1%; p = 0.003). In the multivariate logistic regression analysis, atrial arrhythmias during VV-ECMO were independently associated with increased odds of in-hospital mortality (odds ratio, 2.21; 95% confidence interval, 1.08-4.55; p = 0.03), after controlling for Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score, acute renal failure, total norepinephrine dose, and total cannulation time. CONCLUSIONS: New-onset atrial arrhythmias are a frequent complication during VV-ECMO and are independently associated with excessive in-hospital mortality. Thus, their presence may serve as an important prognostic tool in this patient population.

APA Citation

Li, Cecilia; Pajoumand, Mehrnaz; Lambert, Kerry; Najia, Laila; Bathula, Allison L.; Mazzeffi, Michael A.; Galvagno, Samuel M.; Tabatabai, Ali; Grazioli, Alison; Dahi, Siamak; Hochberg, Eric S.; and Plazak, Michael E., "New-Onset Atrial Arrhythmias Are Independently Associated With In-Hospital Mortality in Veno-Venous Extracorporeal Membrane Oxygenation" (2022). GW Authored Works. Paper 1197.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1197

Department

Anesthesiology and Critical Care Medicine