Abstract
BackgroundAlthough the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea.MethodsThis was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea. The records of all patients who required ECMO for acute respiratory failure between 2012 and 2015 were retrospectively reviewed, and the utilization of ECMO was analyzed over time.ResultsDuring the study period, 5552 patients received ECMO in Korea as a whole, and a total of 2472 patients received ECMO at the participating 16 hospitals. We analyzed 487 (19.7%) patients who received ECMO for respiratory failure. The number of ECMO procedures provided for respiratory failure increased from 104 to 153 during the study period. The in-hospital survival rate increased from 30.8% to 35.9%. The use of prone positioning increased from 6.8% to 49.0% (p < 0.001), and the use of neuromuscular blockers also increased from 28.2% to 58.2% (p < 0.001). Multiple regression analysis showed that old age (OR 1.038 (95% CI 1.022, 1.054)), use of corticosteroid (OR 2.251 (95% CI 1.153, 4.397)), continuous renal replacement therapy (OR 2.196 (95% CI 1.135, 4.247)), driving pressure (OR 1.072 (95% CI 1.031, 1.114)), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality.ConclusionsUtilization of ECMO and survival rates of patients who received ECMO for respiratory failure increased over time in Korea. The use of pre-ECMO prone positioning and neuromuscular blockers also increased during the same period.
Highlights
The utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO
A recent epidemiologic report in Germany showed that ECMO utilization for severe respiratory failure significantly increased from 2007 until 2012, and in-hospital survival increased over time as well [8]
The annual number of ECMO cases at 16 institutions varied widely: eight centers had fewer than 20 cases per year and the other eight centers had more than 30 cases per year, with two of those centers having had more than 120 cases per year
Summary
The utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea. Crossover to ECMO occurred in 28% of patients in the conventional group, who showed a high mortality rate of 57% This suggests that ECMO can be used in severe ARDS patients who do not benefit from conventional treatment. We sought to determine whether there has been an improvement in the survival rate of patients who received ECMO support for acute respiratory failure in Korea. We evaluated the changes over time in the survival rates of patients supported with ECMO for severe respiratory failure and the factors associated with the survival rate
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