Five‐Year Results of 121 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation at Fu Wai Hospital

Abstract

Since 2004, our institution has adopted venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatments. In this study, we reviewed our experience with ECMO support and tried to identify predictors of in-hospital mortality. We retrospectively analyzed the clinical records of 121 consecutive patients receiving ECMO. Patients were divided into adult and pediatric groups and analyzed separately. Demographics, clinical characteristics at the time of ECMO implantation, ECMO-related complications, and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A P value ≤ 0.05 was accepted as significant. Sixty-eight adult patients and 53 pediatric patients were included in this study. In adult patients, 52 were weaned from ECMO and 43 survived upon discharge. After univariate analysis, ECMO setup location, receiving cardiopulmonary resuscitation before ECMO, leg ischemia, hemolysis, acute renal failure (ARF), neurological dysfunction, and multiple organ dysfunction syndrome were associated with in-hospital death. In multiple logistic regression analyses, leg ischemia (OR 14.68, 95% CI 1.67-129.1), ARF (OR 12.14, 95% CI 2.5-58.8), and neurological dysfunction (OR 49.0, 95% CI 2.28-1051.96) were risk factors associated with in-hospital mortality. Patients put on ECMO in the operating room had a better chance of survival (OR 0.078, 95% CI 0.013-0.417). In pediatric patients, 30 were weaned from ECMO and 26 survived upon discharge. After univariate analysis, age, weight, and eight ECMO complications were associated with in-hospital death. In multiple logistic regression analyses, ARF (OR 24.0, 95% CI 4.2-137.3) was a risk factor associated with in-hospital mortality. A P value of 0.921 and >0.99 was obtained by the Hosmer-Lemeshow test, and the area under the curve was 0.863 and 0.867 for adult and pediatric patients, respectively. The overall survival rate was 57%. ECMO is a justifiable alternative treatment for refractory cardiac and/or pulmonary dysfunction which could rescue more than 50% of carefully selected patients. Higher survival rates could be achieved by preventing ECMO complications.

Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation

“…Despite the overall lower than expected 90-day mortality rate in our cohort [13,[28][29][30], we confirm that positive FB at day 3 and CRRT during the first 3 days on ECMO are independent risk factors for mortality [13,28,30,31].…”

“…Of these, 115 received ECMO for primarily cardiac causes, whereas 57 had ECMO for acute respiratory failure (53 patients for ARDS, 4 patients for end-stage respiratory failure). Median ICU LOS was 18 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and median hospital LOS was 35 (21-59) days. Overall 90-day mortality was 24 %.…”

Extracorporeal Life Support

“…Groups from Europe, Asia and Australia have published studies examining a few dozen to several hundred patients at a time. 4–7 However, the University of Michigan Hospital, in Ann Arbor, Michigan, has treated the largest number of patients with ECLS the world over. We previously reviewed and presented the results of the first 1000 patients treated with ECLS at the University of Michigan.…”

Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score

“…The literature reports that hospital survival rates after being supported by ECMO range widely from 20% to 65%. 1,2,3,4 Since the indications for ECMO used to support a patient with cardiac or respiratory failure can differ greatly, it is important to consider these two populations as different when doing specific analyses.…”