Association between epinephrine and the mortality of patients with venoarterial extracorporeal membrane oxygenation: A retrospective analysis based on MIMIC-IV database

Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in cardiogenic shock patients to support them clinically and hemodynamically to allow for recovery of stunned or hibernating myocardium. It is limited and conflicting if the use of epinephrine has been associated with deteriorated outcomes. The objective of this study was to investigate the association of epinephrine with 28-day mortality in these patients. Methods We involved cardiogenic shock patients treated with VA-ECMO from the Medical Information Mart for Intensive Care (MIMIC)-IV database, and these patients were categorized into epinephrine group(epinephrine with or without any other inotropic therapy) and no-epinephrine group. Long-rank test was used to analysis the difference of 28-day mortality between the two groups. Demographic characteristics and clinical outcomes of patients were described and compared across the two cohorts. Univariable and multivariable Cox proportional hazard models were then performed to investigate the relationship between epinephrine treatment and mortality, controlling other confounders. Finally, we used restricted cubic spline analysis to examine the impact of cumulative epinephrine use on 28-day mortality. Results We categorized 51 and 19 patients in the epinephrine group and no-epinephrine group, respectively. In Long-rank test, compared to the no-epinephrine group, the epinephrine group was associated with the increased 28-day mortality (P = 0.017). In multivariate Cox regression analysis, epinephrine were associated with mortality [hazard ratio = 2.38(1.08–5.26); P = 0.032] after adjustment for age group. Moreover, We found no significant relationship between the cumulative dose of epinephrine and mortality. Conclusion In patients with VA-ECMO treatment, epinephrine therapy was associated with increased 28-day mortality.However, the cumulative dose of epinephrine demonstrated no significant association with mortality.