Right Ventricular Dysfunction and Mortality after Cannulation for Venovenous Extracorporeal Membrane Oxygenation

Abstract

Objectives: To assess the prevalence and prognostic value of right ventricular dysfunction as measured by echocardiography in patients treated with venovenous extracorporeal membrane oxygenation. Design: Retrospective cohort study. The primary endpoint was survival to discharge. Survival to extracorporeal membrane oxygenation decannulation was the secondary endpoint. Setting: ICU at an academic quaternary medical center. Subjects: Sixty-four consecutive patients treated with venovenous extracorporeal membrane oxygenation between January 2013 and December 2018 with an echocardiogram performed after cannulation. Interventions: Transthoracic or transesophageal echocardiography was used to assess several standard right and left ventricular characteristics after cannulation with venovenous extracorporeal membrane oxygenation. Measurements and Main Results: No single echo variable was predictive of outcomes. Composite markers such as right ventricular dysfunction (right ventricular dilation and abnormal septal motion) or a small dynamic left ventricle (left ventricle internal diastolic diameter < 4.0 cm and left ventricular ejection fraction > 60%) were associated with significantly decreased survival to decannulation (45% vs 83%; p < 0.01) and survival to hospital discharge (32% vs 64%; p = 0.02). Regression models confirmed the absence of both right ventricular dysfunction, and small left ventricle was highly predictive of increased survival to decannulation (odds ratio, 6; 95% CI, 1.87-19.28; p < 0.01) and discharge (odds ratio, 3.86; 95% CI, 1.29-11.55; p = 0.02). Conclusions: Echocardiographic variables consistent with right ventricular dysfunction or a small dynamic left ventricle were associated with decreased survival to decannulation and hospital discharge. These results enhance prognostic capabilities while implicating right ventricular dysfunction in the high mortality observed in this patient population.