Relationship between the dynamic trajectory of biomarkers for bleeding, thrombosis and infection in patients on veno-arterial extracorporeal membrane oxygenation and their causal association with ICU mortality

Venoarterial ECMO (VA-ECMO) is a subset in which both mechanical circulatory support as well as gas exchange functions are taken over by the ECMO machine to provide a bridge for patients in severe cardiorespiratory failure. However, it is not without complications. The three most common and fatal complications encountered in ECMO patients are- Bleeding, thrombosis and infection. Hence, to monitor the progress of patients on ECMO we need to assess for these complications from time to time which can be done by monitoring the levels of various biomarkers. Certain tests are routinely performed at our institute to monitor ECMO patients. However, till now no research is available to show the utility of point-of-care biomarker tests for bleeding, thrombosis and infection and how the results of these can be correlated with each other and also to predict the outcome of patients on ECMO. Most of the data available till now is from retrospective, observational studies with very little literature available from Indian population. Most studies also focus on a single outcome measure and do not study the correlation among various biomarkers for bleeding/thrombosis/infection and their causal association with mortality. Thus, we wish to undertake this research to study the correlation between biomarkers for bleeding, thrombosis and infection in patients on VA-ECMO post cardiac surgery in the ICU and their causal association with the final outcome of the patients in ICU. Also, we wish to develop an AIIMS scoring for 5 best biomarkers for prognostic screening in VA-ECMO patients.