PB1043 - Consumptive coagulopathy is associated with poor neurological outcome in patients with refractory VT/VF cardiac arrest requiring extracorporeal cardiopulmonary resuscitation.

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

AG

Alejandra Gutierrez, Md

Assistant Professor Cardiovascular Critical Care
University of Minnesota Medical Center: University of Minnesota Health
Wayzara, Minnesota, United States

Co-Author(s)

NR

Nelly C. Rojas-Salvador

Internal Medicine Resident
University of Minnesota
Minneapolis, Minnesota, United States
MS

Marie Steiner

Professor, Division of Pediatric Critical Care Medicine & Hematology Oncology
University of Minnesota
Minneapolis, Minnesota, United States
AM

Alexandra Marquez

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States
TA

Tamas Alexy

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States
AE

Andrea M. Elliott

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States
DY

Demetris Yannopoulos

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States
JB

Jason A. Bartos

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States

Background: The post cardiac arrest syndrome is associated with altered hemostasis with trauma associated with CPR, hypothermia and widespread activation of the inflammatory and coagulation cascade. This is aggravated further by the foreign surface in the extracorporeal circuit leading to a coagulofibrinolytic imbalance.

Aims: We examined the serial changes of consumptive coagulopathy markers and their association with neurologic outcomes.

Methods: A single-center, retrospective cohort study of consecutive patients with VT/VF cardiac arrest meeting criteria for ECMO-facilitated resuscitation (ECPR) between December 2015 and January 2023 were included. Consumptive coagulopathy markers (INR, D-dimer, platelet count, antithrombin III and fibrinogen) were obtained after (veno-arterial extra corporeal membrane oxygenation) VA ECMO cannulation and serially on day 1, 2 and 3. We compared the coagulation profiles of patients who had a neurologically favorable outcome (defined as Cerebral Performance Categories (CPC) 1-2) and those with a neurologically unfavorable outcome (CPC 3-5).

Results: Of 258 patients admitted with a VT/VF arrest requiring VA ECMO support, 82 (32%) survived to hospital discharge. Of these, 87% (71/82) survived with favorable neurological outcome. Prolonged INR, elevated D-dimer levels and decreased ATIII levels were associated (p < 0.05) with neurologically unfavorable survival and decreased over time (p < 0.05)(Figure1). Platelet count and fibrinogen levels were not associated with neurological outcomes. In adjusted analysis (including age, lactate, CPR time and use of dual antiplatelet therapy), each point increase in the INR on day 1, 2 and 3 was associated with neurologically unfavorable survival (OR 4.4, p=0.01; OR 7.14, p=0.04; OR 8.5, p=0.03 respectively).

Conclusion(s): Markers of consumptive coagulopathy are associated with unfavorable neurological outcome in patients presented with VT/VF cardiac arrest supported by VA ECMO.