From Imaging to Insight: Sarcopenia as a Stratifying Marker in VA-ECMO Mortality

Background: With myriad factors influencing mortality among VA-ECMO patients post-postcardiotomy shock, pinpointing the risk factors remains challenging. This study aims to examine the understudied role of sarcopenia as measured by muscle area and outcomes in patients undergoing VA-ECMO implantation.

Methods: We retrospectively examined 439 consecutive patients who underwent implantation of an ECMO at our institution from January 2012 to January 2023. Among the patients with VA-ECMO implanted for postcardiotomy shock, we identified 144 patients who had a perioperative computed tomography and were able to analyze. Cross-sectional areas of the psoas muscles at the level of the L3–L4 vertebra were measured, and the pectoralis muscle area included the sum of the pectoralis major and pectoralis minor muscles at the level of the fourth thoracic vertebra (T4). Sarcopenia was defined as having the lowest tertile muscle area by gender. The primary endpoint was 30-day mortality. Further, we analyzed complications rate and ICU stay between the two groups.

Results: After performing measurements of 108 psoas muscle areas and 134 pectoralis muscle areas we identified 54 sarcopenic patients (37.5%) and 90 (62.5%) nonsarcopenic. Baseline characteristics did not differ between the two groups. The stark disparity lay in 30-day mortality: a daunting 81.5% in the sarcopenic group compared to 64.4% in their nonsarcopenic counterparts (p = 0.029). Multivariable regression analysis indicated low psoas muscle area index (PMAi), aortic surgery, and history of heart failure as independent predictors of mortality in the first 30 days. There were no differences in complication rates and ICU stay between the two groups.

Conclusion: In the age of advanced imaging, sarcopenia, characterized by the psoas or pectoral muscle area, clearly stands out as a critical indicator of heightened mortality post-VA-ECMO implantation. Thus, it holds promise as a supplemental tool for more precise risk stratification.

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Artikel online veröffentlicht:
13. Februar 2024