Does sex matter in patients who need support with veno-arterial ECMO?

Veno-arterial extracorporeal membrane oxygenation support (VA-ECMO) is an effective therapy in refractory cardiogenic shock and cardiorespiratory arrest. Sex-related differences regarding presentation and outcomes are not well stablished in this scenario.

Descriptive, retrospective and single-center study that includes all patients who required VA-ECMO support between 2021 and 2023. The main objective was to compare clinical characteristics, evolution and mortality in both sexes.

78 patients were included: 79.5% men and 20.5% women, with a mean age of 61.2±10.1 years. 21.8% of patients had history of heart failure, of which 88.2% had ventricular dysfunction. Table 1 shows VA-ECMO indications. No statistically significant differences were detected according to sex, although it is worth mentioning that the arrhythmic storm subgroup was composed exclusively by men (11.3%vs0%, p=0.334) and that eCPR was almost three times more frequent in men (32.3 %vs12.5% s, p=0.211). All patients were treated in INTERMACS 1-2 situation and mean lactic acid at start of VA-ECMO was 10.1±5.9 mmol/L, with no differences regarding sex. Duration of VA ECMO care was 4.96 ± 4.4 days.Cannulation was peripheral in 89.7% and central in 10.3%, with central access being twice as common in women (18.8%vs8.1%, p=0.350). Femoral access was the most used (91.0%), while the axillary access was used only in 5.3% and more regularly in women (20%vs1.6%, p=0.023). A distal perfusion line was implanted in 67.5%, less frequently in women (43.8%vs73.8%, p=0.022), probably in relation to the higher rate of central and axillary access. 76.9% of distal perfusion lines were implanted during cannulation. Additionally,44.9% required a ventricular unloading device (balloon in 37.2% and Impella in 7.7%).Complication rate during support was 69.3% (71.7% in men vs 60.0% in women, p = 0.532), the most repeated being severe bleeding 54.7% (53.3% in men vs 60% in women, p=0.643 ) and stroke 28% (26.7% in men vs women 33.3%,p=0.749). The weaning rate was 65.2% while 23.8% required urgent heart transplant or other type of circulatory support, with no differences between both sexes. Overall mortality rate was 58.4%(62.3%vs43.8%, p=0.180 in men and women respectively). Table 2 shows the mortality rates according to indication. In the univariate analysis, eCPR (77.3vs50.1%,p=0.034),absence of distal perfusion line (76.0vs49.0%,p=0.025), appearance of serious hemorrhagic complications during support (28/41 (68.3vs42.4%,p=0.026) and weaning (34.1vs87.5%,p<0.011) were directly associated with mortality.