Survival of septic adults compared with nonseptic adults receiving extracorporeal membrane oxygenation for cardiopulmonary failure: A propensity-matched analysis
Journal
Journal of Critical Care
Journal Volume
28
Journal Issue
4
Pages
532.e1-10
Date Issued
2013
Author(s)
Lee C.-W.
Ko W.-J.
Tsai P.-R.
Hu F.-C.
Abstract
Purpose: Limited data on the outcomes of adults with active sepsis undergoing extracorporeal membrane oxygenation (ECMO) exist. Materials and Methods: We analyzed our prospective database for adults undergoing their first ECMO from 2001 to 2009. Patients with preexisting sepsis had newly emerging or uncontrolled infections precipitating refractory respiratory and/or circulatory failure within 7 days preceding ECMO. Propensity score matching was performed to equalize potential prognostic factors between patients with and patients without sepsis. Results: Of the 514 adults receiving their first ECMO, 108 with preexisting sepsis were matched with 108 without sepsis by propensity score. Overall survival to discharge did not differ between those with (28.7%) and those without sepsis (37.0%; P = .192). When venovenous ECMO and venoarterial ECMO were considered separately, survival tended to be worse for septic patients on venoarterial ECMO (24.4%) compared with nonseptic adults on venoarterial ECMO (34.9%; P = .147). After adjustments for age, stroke, acute myocarditis, inter-extracorporeal cardiopulmonary resuscitation, and post-ECMO renal and neurologic deficits by multivariate analysis, the increased risk of mortality persisted for septic adults receiving venoarterial ECMO (hazard ratio, 2.54; 95% confidence intervals, 1.75-3.70; P < .01). Patients on venovenous ECMO had similar outcomes regardless of preexisting sepsis. Conclusions: Preexisting sepsis is not a contraindication for ECMO. However, venoarterial ECMO should be used with caution, given active sepsis. ? 2013 Elsevier Inc.
SDGs
Other Subjects
adolescent; adult; age; aged; anesthesiological procedure; article; cardiopulmonary insufficiency; cerebrovascular accident; controlled study; extracorporeal oxygenation; female; human; ischemia; kidney disease; major clinical study; male; mortality; myocarditis; neurologic disease; nonsepsis; overall survival; prognosis; propensity score; prospective study; respiratory failure; resuscitation; sepsis; survival; Taiwan; venoarterial extracorporeal oxygenation; venovenous extracorporeal oxygenation; adults; comparative study; ECMO; extracorporeal life support; heart failure; microbiology; middle aged; respiratory failure; risk factor; sepsis; treatment outcome; Adults; ECMO; Extracorporeal life support; Sepsis; Adolescent; Adult; Age Factors; Aged; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Hospital Mortality; Humans; Male; Middle Aged; Prognosis; Propensity Score; Prospective Studies; Respiratory Insufficiency; Risk Factors; Sepsis; Treatment Outcome
Publisher
W.B. Saunders
Type
journal article