INTRODUCTION
Extracorporeal membrane oxygenation (ECMO) is a validated technique for
the temporary treatment of circulatory and/or respiratory failure(1).
Although the indications are well defined(2), contraindications are not
as clear and should be assessed on a patient-specific reasoning based on
the clinical presentation. Apart from the obvious and irreversible
multi-organ failure, the decision to not implement Veno-Arterial ECMO
(VA-ECMO) is the result of a multi-disciplinary assessment between
health professionals including the heart surgeon and the intensivist
physician. Moreover, the decision-making process has to be extremely
quick considering the high instability of such critically ill patients.
Acidosis with a blood pH<7 is in real life recognized by most
physicians as a contraindication to VA-ECMO placement, but without
strong evidence to support this statement. In the SAVE score, serum
bicarbonate level (≤15 mmol/L) was identified as a poor prognostic
factor(3), but without any mention to blood pH specifically. We
previously explored that pH<7 appeared to be a poor prognostic
factor but at that time we had much less patients in our series (1).
Data in the literature of VA-ECMO using these simple biological
parameters to play a role in the decision-making process are scarce
(4,5).
We sought to investigate the proportion of patients implanted with low
pH to compare the survival between groups according to pH levels at
cannulation in our VA-ECMO cohort.