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Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy
BACKGROUND: The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has rapidly increased in recent years. Today, applications of V-V ECMO include a variety of clinical conditions such as acute respiratory distress syndrome (ARDS), bridge to lung transplantation and primary graft dysfu...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10267924/ https://www.ncbi.nlm.nih.gov/pubmed/37324096 http://dx.doi.org/10.21037/jtd-22-1273 |
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author | Neumann, Elena Sahli, Sebastian D. Kaserer, Alexander Braun, Julia Spahn, Muriel A. Aser, Raed Spahn, Donat R. Wilhelm, Markus J. |
author_facet | Neumann, Elena Sahli, Sebastian D. Kaserer, Alexander Braun, Julia Spahn, Muriel A. Aser, Raed Spahn, Donat R. Wilhelm, Markus J. |
author_sort | Neumann, Elena |
collection | PubMed |
description | BACKGROUND: The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has rapidly increased in recent years. Today, applications of V-V ECMO include a variety of clinical conditions such as acute respiratory distress syndrome (ARDS), bridge to lung transplantation and primary graft dysfunction after lung transplantation. The purpose of the present study was to investigate in-hospital mortality of adult patients undergoing V-V ECMO therapy and to determine independent predictors associated with mortality. METHODS: This retrospective study was conducted at the University Hospital Zurich, a designated ECMO center in Switzerland. Data was analyzed of all adult V-V ECMO cases from 2007 to 2019. RESULTS: In total, 221 patients required V-V ECMO support (median age 50 years, 38.9% female). In-hospital mortality was 37.6% and did not statistically vary significantly between indications (P=0.61): 25.0% (1/4) for primary graft dysfunction after lung transplantation, 29.4% (5/17) for bridge to lung transplantation, 36.2% (50/138) for ARDS and 43.5% (27/62) for other pulmonary disease indications. Cubic spline interpolation showed no effect of time on mortality over the study period of 13 years. Multiple logistic regression modelling identified significant predictor variables associated with mortality: age [odds ratio (OR), 1.05; 95% confidence interval (CI): 1.02–1.07; P=0.001], newly detected liver failure (OR, 4.83; 95% CI: 1.27–20.3; P=0.02), red blood cell transfusion (OR, 1.91; 95% CI: 1.39–2.74; P<0.001) and platelet concentrate transfusion (OR, 1.93; 95% CI: 1.28–3.15; P=0.004). CONCLUSIONS: In-hospital mortality of patients receiving V-V ECMO therapy remains relatively high. Patients’ outcomes have not improved significantly in the observed period. We identified age, newly detected liver failure, red blood cell transfusion and platelet concentrate transfusion as independent predictors associated with in-hospital mortality. Incorporating such mortality predictors into decision making with regards to V-V ECMO use may increase its effectiveness and safety and may translate into better outcomes. |
format | Online Article Text |
id | pubmed-10267924 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-102679242023-06-15 Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy Neumann, Elena Sahli, Sebastian D. Kaserer, Alexander Braun, Julia Spahn, Muriel A. Aser, Raed Spahn, Donat R. Wilhelm, Markus J. J Thorac Dis Original Article BACKGROUND: The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has rapidly increased in recent years. Today, applications of V-V ECMO include a variety of clinical conditions such as acute respiratory distress syndrome (ARDS), bridge to lung transplantation and primary graft dysfunction after lung transplantation. The purpose of the present study was to investigate in-hospital mortality of adult patients undergoing V-V ECMO therapy and to determine independent predictors associated with mortality. METHODS: This retrospective study was conducted at the University Hospital Zurich, a designated ECMO center in Switzerland. Data was analyzed of all adult V-V ECMO cases from 2007 to 2019. RESULTS: In total, 221 patients required V-V ECMO support (median age 50 years, 38.9% female). In-hospital mortality was 37.6% and did not statistically vary significantly between indications (P=0.61): 25.0% (1/4) for primary graft dysfunction after lung transplantation, 29.4% (5/17) for bridge to lung transplantation, 36.2% (50/138) for ARDS and 43.5% (27/62) for other pulmonary disease indications. Cubic spline interpolation showed no effect of time on mortality over the study period of 13 years. Multiple logistic regression modelling identified significant predictor variables associated with mortality: age [odds ratio (OR), 1.05; 95% confidence interval (CI): 1.02–1.07; P=0.001], newly detected liver failure (OR, 4.83; 95% CI: 1.27–20.3; P=0.02), red blood cell transfusion (OR, 1.91; 95% CI: 1.39–2.74; P<0.001) and platelet concentrate transfusion (OR, 1.93; 95% CI: 1.28–3.15; P=0.004). CONCLUSIONS: In-hospital mortality of patients receiving V-V ECMO therapy remains relatively high. Patients’ outcomes have not improved significantly in the observed period. We identified age, newly detected liver failure, red blood cell transfusion and platelet concentrate transfusion as independent predictors associated with in-hospital mortality. Incorporating such mortality predictors into decision making with regards to V-V ECMO use may increase its effectiveness and safety and may translate into better outcomes. AME Publishing Company 2023-03-22 2023-05-30 /pmc/articles/PMC10267924/ /pubmed/37324096 http://dx.doi.org/10.21037/jtd-22-1273 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Neumann, Elena Sahli, Sebastian D. Kaserer, Alexander Braun, Julia Spahn, Muriel A. Aser, Raed Spahn, Donat R. Wilhelm, Markus J. Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title | Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title_full | Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title_fullStr | Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title_full_unstemmed | Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title_short | Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
title_sort | predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10267924/ https://www.ncbi.nlm.nih.gov/pubmed/37324096 http://dx.doi.org/10.21037/jtd-22-1273 |
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