Background:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) supports circulation in severe cardiogenic shock. Patients with V-A ECMO have a poor prognosis, especially after resuscitation.
Aim:
The goal of the current study was to evaluate whether higher levels of serum high-sensitive Troponin T (hsTnT) correlate with an increased rate of mortality in patients with VA-ECMO after resuscitation.
Methods:
This study is a prospective observational study in patients supported with V-A ECMO in the university hospital Regensburg from 30.08.2022 to 11.10.2025. HsTnT serum levels were measured directly after implantation of V-A ECMO and the day after.
Results:
112 patients with VA-ECMO after resuscitation were included in the analysis (mean 56 years old, 80% male). Duration of V-A ECMO support was in median 5 days. 54 patients survived until discharge from hospital. There was no significant difference in preexisting comorbidities regarding patients suffering from death before discharge from hospital. Deceased patients showed significantly higher levels of hs-TnT than survivors directly after ECMO implantation and the day after (3802 ng/l vs. 1235 ng/l, p=0.014 directly after implantation; 11570 ng/l vs 1249 ng/l p>0.001 at day 1 after implantation). Regarding ROC-analysis, hs-TnT showed promising value in predicting mortality (AUC 0.63; sensitivity 81%, specifically 43% for a hs-TnT of 397 ng/l directly after implantation; AUC 0,72 sensitivity 81%, specifically 48% for a hs-TnT of 1206 ng/l at day 1 after implantation).
In binary logarithmic regression, the logarithm of hs-TnT at implantation as well as the day after were shown as significant and independent predictors for mortality alongside diabetes (directly after implantation: HR 1.95; IQR: 1.15-3.29; p< 0.05 for lghs-TnT, HR 2.62; IQR: 1.39-4.93; p< 0.05 for diabetes; at day 1 after implantation: HR 2.84; IQR: 1.65-4.90; p< 0.001 for lghs-TnT, HR 2.77; IQR: 1.42-5.41; p< 0.05 for diabetes), opposite to age, sex, the duration of ECMO-therapy, hypertension or the presence of an acute coronary syndrome (each p= n.s.).
Conclusion:
Patients with V-A ECMO show complex clinical pictures with poor prognosis and many possible causes of mortality. Nevertheless, patients surviving until discharge from hospital showed significantly lower levels of hs-TnT at the beginning of ECMO-therapy and the day after. Additionally, binary logarithmic regression showed hs-TnT as a potential significantly independent predictor for mortality, but further studies are required to confirm these findings.
