Immediate hemodilution following venoarterial extracorporeal membrane oxygena-tion initiation:implications for organ function and treatment strategies in cardiac patients
Objective To investigate the effect of immediate hemodilution following venoarterial extracorporeal membrane oxygenation(VA-ECMO)initiation on organ function and treatment strategies in cardiac patients.Methods We retrospectively analyzed the clinical data of 50 patients who received VA-ECMO in the Cardiology Department of First Medical Center of Chinese PLA General Hospital between January 2019 and January 2023.According to the decrease in hematocrit(Hct)after VA-ECMO initiation,the patients were divided into the Hct decrease≥30%(HctΔ30%+)group(n=17)and the Hct decrease<30%(HctΔ30%-)group(n=33).The two groups were compared in their biomarkers of organ function,blood transfusion,intra-aortic balloon pump(IABP),and continuous renal replacement therapy(CRRT).SPSS statistics 25.0 was used for data analysis.Based on the data type,t test,Mann-Whitney U test,Chi-square test,or Fisher's exact test was used for inter-group comparisons.Results The proportion of patients aged 65 years and over was 52.9%(9/17)in HctΔ30%+group and 36.4%(12/33)in the HctΔ30%-group.There was no statistically significant difference between the two groups in the general clinical characteristics and clinical indicators before VA-ECMO initiation(P>0.05).After VA-ECMO initiation,the HctΔ30%+group had greater peaks than the HctΔ30%-group in creatine kinase-myocardial band(CK-MB),aspartic transaminase,and alanine transaminase with statistically significant differences(P<0.05 for all).Compared with HctΔ30%-group,HctΔ30%+group were more likely to receive treatment of IABP(70.6%vs 36.4%)and CRRT(64.7%vs 18.2%),and had higher dose of transfusion of red blood cell suspensions and plasma(P<0.05 for all).Conclusion Patients with a Hct decrease≥30%after VA-ECMO initiation require greater volume of blood transfusion,is associated with more severe organ damage,and have a higher proportion of those undergoing adjunct IABP or CRRT.A Hct decrease≥30%after VA-ECMO initiation can serve as a new clinical indicator,providing an important reference for selecting treatment strategies and improving prognosis.
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