Early Positive Fluid Balance is Associated with Mortality In Patients Treated with Veno-Arterial Extra Corporeal Membrane Oxygenation For Cardiogenic Shock
Résumé
Purpose:
Veno-arterial Extracoporeal Membrane Oxygenation (VA-ECMO) provides circulatory assistance for patients in cardiogenic shock. Large quantities of fluids are often required, especially during the early stages, but can result in a potentially harmful fluid-overload. The objective was to determine the association of early fluid-balance and mortality.
Methods:
Retrospective single center study in 101 VA-ECMO patients between 2013 and 2016. Daily fluid-balance and weight changes over the 5 first days were observed. Analyses between survivors and non-survivors were conducted using Mann-Whitney tests and logistic regression multivariable and Cox hazard-proportional analyses to determine any association with 28-days mortality.
Results:
Mortality was 47.5%. The fluid-balance was higher in non-survivors at day-1 (47.3[18.1–71.9] vs 19.3[1.5–36.2] mL/kg, p < 0.0001) and day-2 (30.6[14.8–71.0] vs 10.1[-9.8–34.7] mL/kg, p = 0.025), as was the cumulative fluid-balance over the first 5 days (107.3[40.5–146.2] vs 53.0[7.5–74.3] mL/kg, p = 0.04). The administration of unintentional fluids (used for preparation and infusion of drugs) represented an important part of the administrated fluids (15–23 mL/kg/day). A significant but moderate correlation was observed between fluid-balance and weight variations over the 5 days (r values ranging from 0.36 to 0.54). Among other parameters, day-1 fluid-balance was independently associated with mortality (OR = 14.34 [1.58–129.79], p = 0.02) and day-1 and day-2 with time to death (HR = 8.26 [1.12–60.98], p = 0.04 and 2.89 [1.26–6.65], p = 0.01). A threshold of 38.8 mL/kg predicted mortality with a sensitivity of 60% and specificity of 83% (Area Under the Curve: 0.749).
Conclusion:
Early positive fluid-balance is associated with mortality in VA-ECMO patients.