Kowalewski et al reported pre-ECMO findings predictive of outcome for an elderly adult with cardiogenic shock placed on venoarterial extracorporeal life support. Some patients face an ominous prognosis and placement of ECMO is not recommended. The authors are from multiple institutions participating in the Extracorporeal Life Support Organization Registry (ELSOR).
Patient selection: cardiogenic shock, age >= 70 years, cardiac arrest excluded
Patients with an ominous prognosis:
(1) sepsis
(2) age > 75 years AND decompensated heart failure
(3) age > 75 years AND aortic surgery
(4) age 76 to 80 years AND duration of support > 216 hours (9 days)
(5) age > 80 years AND duration of support > 96 hours (4 days)
(6) major comorbidities prior to placement
(7) prolonged low-flow time
(8) blood lactate concentration > 6 mmol/L
(9) suboptimal/critical clinical conditions prior to ECMO-related event
(10) life expectancy less than 1 year
(11) malnutrition
where:
• Items 4, 5, and 9 would only be known after ECMO started.
The presence of one or more of these findings make the use of ECMO essentially futile.
