Abstract
IntroductionMortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. The objectives of this study were to assess the factors associated with outcome of patients undergoing ECMO in a large ECMO referral centre and to compare veno-arterial ECMO (VA ECMO) with veno-venous ECMO (VV ECMO).MethodsWe reviewed a prospectively obtained ECMO database and patients' medical records between January 2005 and June 2011. Demographic characteristics, illness severity at admission, ECMO indication, organ failure scores before ECMO and the ECMO mode and configuration were recorded. Bleeding, neurological, vascular and infectious complications that occurred on ECMO were also collected. Demographic, illness, ECMO support descriptors and complications associated with hospital mortality were analysed.ResultsECMO was initiated 158 times in 151 patients. VA ECMO (66.5%) was twice as common as VV ECMO (33.5%) with a median duration significantly shorter than for VV ECMO (7 days (first and third quartiles: 5; 10 days) versus 10 days (first and third quartiles: 6; 16 days)). The most frequent complications during ECMO support were bleeding and bloodstream infections regardless of ECMO type. More than 70% of the ECMO episodes were successfully weaned in each ECMO group. The overall mortality was 37.3% (37.1% for the patients who underwent VA ECMO, and 37.7% for the patients who underwent VV ECMO). Haemorrhagic events, assessed by the total of red blood cell units received during ECMO, were associated with hospital mortality for both ECMO types.ConclusionsAmong neurologic, vascular, infectious and bleeding events that occurred on ECMO, bleeding was the most frequent and had a significant impact on mortality. Further studies are needed to better investigate bleeding and coagulopathy in these patients. Interventions that reduce these complications may improve outcome.
Highlights
Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high
Forty patients were transferred to the hospital on ECMO, they were mostly on venous ECMO (VV ECMO) (41% versus 22%, P = 0.002), and in 34 (85%) patients, ECMO was initiated less than 24 hours prior to arrival
Platelet transfusion in veno-arterial ECMO (VA ECMO) may be only related to perioperative haemorrhagic complications, while thrombocytopenia in patients on VV ECMO could be related either to coagulopathy that occurred on ECMO, or illness severity
Summary
Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. The objectives of this study were to assess the factors associated with outcome of patients undergoing ECMO in a large ECMO referral centre and to compare veno-arterial ECMO (VA ECMO) with veno-venous ECMO (VV ECMO). Extracorporeal membrane oxygenation (ECMO) is a rescue therapy to support severe cardiac and/or pulmonary failure. ECMO complications may be mechanical (relating to the ECMO circuit components) or medical [9] The latter are the most frequent and include bleeding, infection, embolism causing vascular and neurological complications, and limb ischaemia. Bloodstream infections during ECMO have been associated with a poor outcome in paediatric patients [17,22] but the association remains uncertain in adults [15,19,23] Bleeding is another frequent adverse event in these patients who are critical ill, exposed to anticoagulation and susceptible to coagulopathy and platelet dysfunction. Mechanical complications and haemolysis have decreased with the introduction of centrifugal pumps, low-resistance polymethylpentene membranes and modern heparin-coated surfaces
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