Abstract 12769: Association of Lung Protective Ventilation and Outcomes in Patients With Cardiogenic Shock on ECLS

Background: In Acute Respiratory Distress Syndrome, lung protective ventilation (LPV) improves patient outcomes by minimizing the risk of ventilator-associated lung injury. For patients with cardiogenic shock (CS) requiring VA-ECLS, the extracorporeal heart-lung circuit provides a unique opportunity to provide LPV. At present, there are limited data regarding optimal ventilator strategies for patients in CS on VA-ECLS. We hypothesized that CS patients on VA-ECLS who require ventilator support will have better outcomes with LPV. Methods: We queried Extracorporeal Life Support Organization (ELSO) registry for hospital admissions between 2009 and 2019 for CS patients on VA-ECLS and mechanical ventilation. Patients with multiple ECLS runs, congenital heart disease, pre-ECLS cardiac arrest, and durable mechanical circulatory support were excluded. We defined LPV as peak inspiratory pressure (PIP24)<30 cm H 2 O at 24 hours on ECLS. ELSO registry does not report tidal volume, hence, PIP24 was used as surrogate for plateau pressure. PIP24 and driving pressure (PIP24 minus PEEP24) at 24 hours (DP24) were also studied as continuous variables. Our primary outcome was survival to discharge. Multivariable analysis adjusted for baseline SAVE score, age, race, BMI, etiology of CS, intubation hours prior to ECMO and history of chronic lung disease. Results: A total of 2,226 CS patients on VA-ECLS were included of which 1904 received LPV. LPV patients had a significantly lower BMI (median 28.28 vs 31.14, p<0.001), and were less sick, as assessed by their baseline SAVE score (-1.79 vs -2.79, p=0.002). The primary outcome of survival to discharge was significantly greater in LPV cohort (47.4% vs 32.6%, p<0.001). Median PIP24 (22 vs 24, p<0.001) as well as DP24 (14.5 vs 16, p<0.001) were significantly lower in those surviving to discharge. Adjusted OR for primary outcome with LPV was 1.69 (p=0.0023). Adjusted OR for primary outcome with incremental rise in PIP24 (0.78, p=0.0003) and DP24 (0.75, p<0.0001) were also statistically significant. Conclusions: In VA-ECLS patients requiring mechanical ventilation, LPV and lower PIP and DP at 24 hours is associated with improved survival to discharge.