Role of age in prognostication of hospital mortality in postcardiotomy patients supported with extracorporeal membrane oxygenation.

INTRODUCTION

Despite the growing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO), there are still no clearly defined criteria for VA-ECMO initiation in postcardiotomy (PC) patients.

AIM

To identify the pre-ECMO risk factors associated with increased hospital mortality, paying special attention to the patients' age.

MATERIAL AND METHODS

Retrospective review of consecutive adult patients supported with PC ECMO for a 16-year period in a tertiary care center. The primary outcome was all-cause mortality. Logistic regression was performed to identify mortality predictors. To determine the optimal age cut-off that most accurately distinguishes between higher and lower probabilities of mortality, the Youden index was used.

RESULTS

A total of 214 patients were enrolled in the final analysis and 55 (25.7%) survived until hospital discharge. Age was a significant mortality predictor with ROC-AUC of 0.596 (0.508-0.685), = 0.033. Multivariable logistic regression showed that age over 60 years (OR = 2.119 (95% CI: 1.055, 4.255), = 0.035), male gender (OR of 0.415, indicating a protective effect) (95% CI: 0.198, 0.869), = 0.020), pre-ECMO vasoactive inotropic score (VIS) (OR = 1.015 (95% CI: 1.002, 1.027), = 0.019), and mechanical ventilation duration before ECMO (OR = 1.053 (95% CI: 1.014, 1.092), = 0.007) remained as independent prognostic factors.

CONCLUSIONS

Our study confirms that advanced age is a prognostic marker of mortality in PC ECMO patients and doubles the mortality risk above 60 years. However, age must be considered alongside other mortality predictors. These findings can significantly contribute to the decision-making process.