Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Abstract

Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

Radiation Exposure in Extracorporeal Life Support

“…31 These patients could continue to have additional radiological testing and further radiation exposure postdischarge in the outpatient setting, adding to their annual and lifetime radiation burden. 32 Indeed, efforts to minimize the CED accrued during the ECMO run and the entire hospital stay could help limit the total lifetime radiation exposure. Unfortunately, despite earnest efforts at our center to limit radiation exposure to as low as reasonably achievable, a select subset was exposed to inordinate doses.…”

Quality of life and mortality among survivors of acute respiratory distress syndrome in South Korea: a nationwide cohort study

“…Considering that chronic respiratory disease-related death is a substantial issue in Asian countries [21], the severe pattern of chronic respiratory diseases such as respiratory disability might affect poorer survival outcomes among South Korean ARDS survivors. In addition, we recently reported that newly developed chronic respiratory diseases were associated with higher 5-year mortality among survivors of ECMO therapy due to respiratory failure or ARDS [22]; thus, ARDS survivors who have a new respiratory disability might also be a high-risk group that needs special attention during healthcare utilization.…”

Comparison of mNGS and conventional culture in non-organ transplant critically ill patients supported by ECMO: a single-center study

“…Nowadays, ECMO is widely used in the intensive care unit (ICU). Timely and correct application of ECMO can effectively improve the survival rate of severe patients and even improve the prognosis ( Oh et al., 2021 ; Kochanek et al., 2022 ). However, the infection rate of severe patients should not be underestimated.…”