Early Albumin Administration in Veno-Arterial Extracorporeal Membrane Oxygenation

Background: The clinical outcome and fluid balance of patients with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or after extracorporeal cardiopulmonary resuscitation (eCPR) may be improved by addressing the high fluid demand with an early albumin administration.

Methods: In this prospective observational study, patients supported with VA ECMO or eCPR received early albumin administration (25 g/L) to prime the VA ECMO system. These patients were compared to patients who received a regimen based solely on balanced crystalloids (crystalloid group) or a regimen based on a 1:4 volume mixture of albumin (10 g/L) and balanced crystalloids (albumin group).

Results: 660 VA ECMO patients (66.4% eCPR) treated between January 2017 and June 2021 were analyzed, whereby 265 patients received crystalloid fluid therapy, 269 patients received albumin therapy, and 126 patients received early albumin therapy. When compared to the albumin and crystalloid groups, patients in the early albumin treatment group had significantly lower cumulative fluid balances (p < 0.05). However, this effect was only observed in the group of eCPR patients and not in patients with cardiogenic shock. Logistic regression revealed albumin administration as an independent predictor of increased survival (Odds ratio 1.66 (1.11-2.47) [95%-CI], p = 0.013). Yet, only eCPR patients showed a survival benefit from albumin administration compared to the crystalloid group (survival of 29.4% vs. 18.8%, p = 0.024).

Conclusion: Early albumin administration in eCPR patients was linked to a significant decline in fluid balance. Moreover, volume therapy with albumin application was an independent predictor for improved survival in eCPR patients.