ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period

Abstract

BackgroundBased on promising results over the past 10 years, the method of extracorporeal membrane oxygenation (ECMO) has developed from being used as a ‘rescue therapy’ to become an accepted treatment option for patients with acute lung failure (ARDS). Subsequently, the indication was extended also to patients suffering from cardiogenic and septic shock. Our aim was to evaluate hospital mortality and associated prognostic variables in patients with lung failure, cardiogenic, and septic shock undergoing ECMO. Furthermore, a cumulative sum (CUSUM) analysis was used to assess the learning curve of ECMO-treatment in our department.MethodsWe retrospectively analysed the data of 131 patients undergoing ECMO treatment in the intensive care unit of the Asklepios Hospital of Langen over the time period from April 2011 to July 2016. We categorised the patients into three groups: lung failure (n = 54); cardiogenic shock (n = 58); and septic shock (n = 19). The primary outcome variable was hospital mortality along with identification of prognostic variables on mortality before initiating ECMO using logistic regression. Second outcome variable was the learning curve of our department in patients with ECMO.Results6-year hospital mortality was 54% in patients with lung failure, 59% in patients with cardiogenic shock, and 58% in patients with septic shock.The CUSUM analysis revealed a typical learning curve with a point of inflection in the year 2014. Patients treated before 2014 had a worse outcome (p = 0.04 whole cohort; p = 0.03 for lung failure). Furthermore, less than 20 treatments per year respectively treatment before 2014 were associated negatively with hospital mortality of lung failure patients showing an odds ratio of 4.04, as well as in the entire cohort with an odds ratio of 3.19.ConclusionFor the first time, a steep ECMO-learning curve using the CUSUM tool has been described. Obviously, the experience with ECMO has to be taken into account when defining the role of ECMO in ARDS, cardiogenic, and septic shock.

Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis

“…Of 2748 references screened, our search yielded 87 potentially relevant studies across the four databases. Sixteen studies reporting on 534 adult patients with septic shock undergoing VA ECMO were included in our systematic review [20,22,[38][39][40][41][42][43][44][45][46][47][48][49][50][51]. All studies were retrospective and observational in nature: there was one multi-centre propensity score matched study, Eleven single-centre retrospective cohort studies, and four single-centre retrospective case series.…”

Immune Mechanisms Underlying Susceptibility to Endotoxin Shock in Aged Hosts: Implication in Age-Augmented Generalized Shwartzman Reaction

“…These comorbid illnesses are presumably susceptible to sepsis/severe sepsis, leading to shock and multi-organ dysfunctions [2]. Mortality due to septic shock has decreased in the past decade thanks to the prompt initiation of appropriate antimicrobial therapy [10] and sophisticated organ support therapies such as extracorporeal membrane oxygenation (ECMO), continuous hemodiafiltration (CHDF), and direct hemoperfusion with immobilized polymyxin B fiber (PMX-DHP) [11,12]. Nevertheless, mortality due to septic shock remains high at approximately 20% [13,14,15].…”

Hypoperfusionssyndrom und kardiogener Schock

“…So konnten OʼNeill et al zeigen, dass in Zentren mit höherer Implantationsfrequenz die Überlebenswahrscheinlichkeit besser ist als in Zentren, in denen eine Impella nur höchstens 4-mal pro Jahr eingesetzt wurde [32]. In Bezug auf das ECLS fanden Banjas et al [33], dass es eine Lernkurve gibt, die im eigenen Zentrum ab einer Fallzahl von mehr als 20 pro Jahr zu beobachten war. Dieses wird auch in aktuellen Positions-bzw.…”