From Imaging to Insight: Sarcopenia as a Marker of Venoarterial Extracorporeal Membrane Oxygenation Mortality in Postcardiotomy Shock

Identifying risk factors for mortality in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients with postcardiotomy shock is challenging due to numerous influencing factors. This study investigates the role of sarcopenia in outcomes for these patients. We retrospectively analyzed 433 patients who underwent ECMO implantation at our institution between 2012 and 2023. Among those with VA-ECMO for postcardiotomy shock, 99 had preoperative computed tomography (CT) scans. We measured the psoas muscle area at the L3-L4 vertebra and the pectoralis muscle area at the level of the left common carotid artery. The primary endpoints were identifying mortality risk factors and assessing survival and weaning success in relation to sarcopenia. We measured 66 psoas and 98 pectoralis muscle areas, identifying 34 sarcopenic (34.3%) and 65 nonsarcopenic (65.7%) patients. Baseline characteristics were similar between groups, except for age. Mortality was significantly higher in the sarcopenic group (85.3% vs. 66.2%; p = 0.042). Multivariable regression analysis identified continuous renal replacement therapy and sarcopenia as independent predictors of mortality. Sarcopenia, as indicated by psoas or pectoralis muscle area, is a significant predictor of increased mortality following VA-ECMO implantation, suggesting its potential use for enhanced risk stratification.