Distelmaier_2014_Crit.Care_18_R24

INTRODUCTION: Risk stratification in patients undergoing extracorporeal membrane oxygenation (ECMO) support following cardiovascular surgery remains challenging, since data on specific outcome predictors are limited. Serum butyrylcholinesterase demonstrated a strong inverse association with all-cause and cardiovascular mortality in non-critically ill patients. We therefore evaluated the predictive value of preoperative serum butyrylcholinesterase levels in patients undergoing veno-arterial ECMO support following cardiovascular surgery.
METHODS: We prospectively included 191 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our registry.
RESULTS: All-cause and cardiovascular mortality were defined as primary study endpoints. During a median follow-up time of 51 months (IQR: 34-71) corresponding to 4197 overall months of follow-up, 65% of patients died. Cox proportional hazard regression analysis revealed a significant and independent inverse association between higher butyrylcholinesterase levels and all-cause mortality with an adjusted hazard ratio (HR) of 0.44 (95%CI 0.25-0.78; P = 0.005) as well as cardiovascular mortality with an adjusted HR of 0.38 (95%CI 0.21-0.70; P = 0.002) comparing the third with the first tertile. Survival rates were higher in patients within the third tertile of butyrylcholinesterase compared to patients within the first tertile at 30 days (68% versus 44%) as well as at 6 years (47% versus 21%).
CONCLUSIONS: The current study revealed serum butyrylcholinesterase as a strong and independent inverse predictor of all-cause and cardiovascular mortality in patients undergoing veno-arterial ECMO therapy following cardiovascular surgery. These findings advance the limited knowledge on risk stratification in patients undergoing ECMO support and represent a valuable addition for a comprehensive decision-making prior to ECMO implantation.