PB1024 - Disseminated intravascular coagulation predicts a poor prognosis for out-of-hospital cardiac arrest patients receiving veno-arterial extracorporeal membrane oxygenation

Background: Out-of-hospital cardiac arrest (OHCA) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) lead to platelet and coagulofibrinolytic derangements, the most severe of which is disseminated intravascular coagulation (DIC).

Aims: We investigated changes in platelet and coagulofibrinolytic markers of OHCA patients who received VA-ECMO after return of spontaneous circulation and tested the hypothesis that DIC predicts a poor prognosis in these patients.

Methods: Out of 255 cardiogenic OHCA patients, 57 who underwent VA-ECMO were retrospectively divided into 27 non-DIC and 30 DIC patients. Platelet counts and global coagulofibrinolytic markers on admission to the emergency department (day 0) and 24 h after admission (day 1) were compared between the groups. Receiver operating characteristic (ROC) curve was constructed for DIC scores on day 1, and area under the ROC curve (AUC) was evaluated for predicting in-hospital death. The survival probabilities of the two groups were analyzed using the Kaplan-Meier method, and results were confirmed by a Cox regression analysis. A logistic regression analysis was performed to confirm the independent association between DIC and in-hospital mortality. Age, sex, and acute physiology and chronic health evaluation score were included as potential confounders.

Results: DIC patients had higher mortality than non-DIC patients (25.9 vs. 70.0%, p=0.001). The AUC for DIC scores on day 1 showed moderate predictive ability for in-hospital death (0.757, p=0.002). A lower probability of survival was observed in DIC patients in comparison to non-DIC patients (p=0.001), which was confirmed by the significant hazard ratio (3.472, p=0.006) of DIC, with adjustment for potential confounders. The adjusted odds ratio of DIC on day 1 (5.67, p=0.005) showed that DIC was an independent predictor of in-hospital death in OHCA patients who underwent VA-ECMO.

Conclusion(s): DIC at 24 h after the induction of VA-ECMO was associated with a poor prognosis in OHCA patients.