The outcome of patients requiring multiple extracorporeal membrane oxygenation: How many runs of ECMO is reasonable?
Journal
International Journal of Artificial Organs
Journal Volume
39
Journal Issue
6
Pages
288-293
Date Issued
2016
Author(s)
Chang, Te-I.
Ponge, Lee-Mei
Wang, Ya-Chen
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has been proven effective in life support for patients with refractory cardiopulmonary failure. Deteriorating patients who have removed their first ECMO support and required second or more courses of ECMO support have rarely been discussed.
Methods and results: All the records of the patients who experienced at least 2 courses of ECMO during single admission were retrieved. Survival was defined as survival to discharge. Demographic data and clinical information were compared between survival and nonsurvival groups. There were 86 patients who received at least 2 courses of ECMO in the 20-year database, and 27 (31.3%) were <18 years old. Of them, 87.3% received 2 runs of ECMO, 10.4% 3 runs, and 2.3% 4 runs. Overall survival rate was 30.2%. The survival rate for patients with 2 runs of ECMO was 33.3% (25 out of 75), 11.1% (1 out of 9) for 3 runs, and 0% (0 out of 2) for 4 runs. Multivariate analysis revealed that only ARF with hemodialysis was the independent risk factor.
Conclusions: The decision to perform repeated ECMO implantation is a complex and difficult process. Despite the arguments debating the consumption of resources and increased complications, there are still nearly 1 out of 3 patients who will survive to discharge. More than 2 courses of ECMO may be carefully considered for further rescue.
Other Subjects
Multivariant analysis; Oxygenation; Risk assessment; Cardiopulmonary failure; Clinical information; Data informations; Demographic data; Extracorporeal membrane oxygenation; Life supports; Multiple extracorporeal membrane oxygenation; Overall survival rates; Survival; Respiratory therapy; lactic acid; adult; adult respiratory distress syndrome; Article; brain ischemia; cardiogenic shock; cardiomyopathy; cardiopulmonary insufficiency; comorbidity; controlled study; coronary artery disease; diabetes mellitus; end stage renal disease; extracorporeal membrane oxygenation device; female; graft rejection; heart left ventricle ejection fraction; human; hypertension; major clinical study; male; medical record review; resuscitation; treatment outcome; adolescent; aged; child; extracorporeal oxygenation; factual database; heart failure; hemodialysis; infant; middle aged; mortality; newborn; preschool child; Respiratory Insufficiency; retrospective study; risk factor; survival rate; treatment outcome; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Databases, Factual; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Humans; Infant; Infant, Newborn; Male; Middle Aged; Renal Dialysis; Respiratory Insufficiency; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome; Young Adult
Publisher
Wichtig Publishing Srl
Type
journal article