Ventricular fibrillation/ventricular tachycardia within 72 h of VA‐ECMO: incidence, outcomes, risk factors, and management

Abstract

Abstract Aims Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is an important technique for the treatment of refractory cardiogenic shock and cardiac arrest; however, the early management of ventricular fibrillation/ventricular tachycardia (VF/VT), within 72 h of VA‐ECMO, and its effects on patient prognosis remain unclear. Methods and results We retrospectively analysed patients at the First Affiliated Hospital of Nanjing Medical University who underwent VA‐ECMO between January 2017 and March 2022. The patients were divided into two groups, VF/VT and nVF/VT, based on whether or not VF/VT occurred within 72 h after the initiation of VA‐ECMO. We utilized logistic regression analysis to evaluate the independent risk factors for VF/VT in patients undergoing VA‐ECMO and to ascertain whether the onset of VF/VT affected 28 day survival rate, length of intensive care unit stay, and/or other clinical prognostic factors. Subgroup analysis was performed for the VF/VT group to determine whether defibrillation affected prognosis. In the present study, 126 patients were included, 65.87% of whom were males (83/126), with a mean age of 46.89 ± 16.23, a 28 day survival rate of 57.14% (72/126), an incidence rate of VF/VT within 72 h of VA‐ECMO initiation of 27.78% (35/126), and 80% of whom (28/35) received extracorporeal cardiopulmonary resuscitation. The incidence of VF/VT resulting from cardiac arrest at an early stage was significantly higher than that of refractory cardiogenic shock (80% vs. 20%; P = 0.022). The restricted cubic spline model revealed a U‐shaped relationship between VF/VT incidence and initial heart rate (iHR), and multivariate logistic regression analysis showed that an iHR > 120 b.p.m. [odds ratio (OR) 6.117; 95% confidence interval (CI) 1.672–22.376; P = 0.006] and hyperlactataemia (OR 1.125; 95% CI 1.016–1.246; P = 0.023) within 1 h of VA‐ECMO initiation were independent risk factors for the occurrence of VF/VT. VF/VT was not found to be associated with the 28 day survival of patients undergoing VA‐ECMO support, nor did it affect other secondary endpoints. Defibrillation did not alter the overall prognosis in patients with VF/VT during VA‐ECMO. Conclusions An iHR > 120 b.p.m. and hyperlactataemia were independent risk factors for the occurrence of VF/VT within 72 h of VA‐ECMO initiation. The occurrence of VF/VT does not affect, nor does defibrillation in these patients improve the overall patient prognosis. Trial registration ChiCTR1900026105.

Keywords

• Veno‐arterial extracorporeal membrane oxygenation
• Ventricular fibrillation/ventricular tachycardia
• Defibrillation
• Prognosis