Outcomes of Severe Systemic Rheumatic Disease Patients Requiring Extracorporeal Membrane Oxygenation

Abstract

Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s), whose may need a VA- or VV-ECMO support. Data focusing on ECMO in SRD patients are scarce and many questions persist. We undertook this study to determine the outcomes and unfavorable outcome-associated factors of severely ill SRD patients requiring ECMO support. This French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality. The secondary outcomes included patient's characteristics (laboratory findings, in-ICU organ-failure treatment(s), SRD-specific manifestations and treatment(s), complications). Were compared the primary and secondary outcomes for the entire population and in the following subgroups : flare-/infection-related admission and VA/VV-ECMO. Ninety patients (male/female ratio : 0.5 ; mean age at admission : 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare ( n = 69, n = 38/31) or infection ( n = 21, n = 10/11). The flow chart reports patients’ outcomes according to the reason for admission and ECMO hook-up. SRD was diagnosed in-ICU for 31 (34.4 %) patients. In-ICU and in-hospital mortality rates were 48.9 % and 51.1%, respectively. Nine patients were bridged to cardiac ( n = 5) or lung transplantation ( n = 4), or left ventricular assist device ( n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality : in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients ; day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients whereas vasculitis independently predicts hospital survey. The main analysis considered VA- and VV-ECMO patients jointly. The reasons for ICU admissions and ECMO canulation, and the characteristics, management and outcomes of these patients obviously differ. However, the analysis aimed to present a comprehensive, real-life picture of ECMO treatment of SRD patients, with separate analyses of VA- and VV-ECMO subgroups thereafter. ECMO support appears to be relevant for critically ill SRD patients, with 49% survival at hospital discharge. Herein, we report the largest series of ECMO-treated, severely ill SRD patients. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.