Abstract
PurposeExtracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. This study compares the predictive value of Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Organ System Failure (OSF) obtained on the first day of ECMO removal, and the Acute Kidney Injury Network (AKIN) stages obtained at 48 hours post-ECMO removal (AKIN48-hour) in terms of hospital mortality for critically ill patients.MethodsThis study reviewed the medical records of 119 critically ill patients successfully weaned from ECMO at the specialized intensive care unit of a tertiary-care university hospital between July 2006 and October 2010. Demographic, clinical, and laboratory data were collected retrospectively as survival predictors.ResultsOverall mortality rate was 26%. The most common condition requiring ECMO support was cardiogenic shock. By using the areas under the receiver operating characteristic (AUROC) curve, the Sequential Organ Failure Assessment (SOFA) score displayed good discriminative power (AUROC 0.805±0.055, p<0.001). Furthermore, multiple logistic regression analysis indicated that daily urine output on the second day of ECMO removal (UO24–48 hour), mean arterial pressure (MAP), and SOFA score on the day of ECMO removal were independent predictors of hospital mortality. Finally, cumulative survival rates at 6-month follow-up differed significantly (p<0.001) for a SOFA score≤13 relative to those for a SOFA score>13.ConclusionsFollowing successful ECMO weaning, the SOFA score proved a reproducible evaluation tool with good prognostic abilities.
Highlights
Extracorporeal membrane oxygenation (ECMO) has been utilized in critically ill patients such as those with severe, reversible myocardial dysfunction and life-threatening respiratory failure
This study investigated the prognostic factors and compared the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II [4], Sequential Organ Failure Assessment (SOFA) [5], Organ System Failure (OSF) number [6], and Acute Kidney Injury Network (AKIN) stages [7] for predicting hospital mortality and short-term prognosis in patients being weaned from ECMO support
The following retrospective data were obtained: demographic data; primary diagnosis for ECMO implementation; whether the patient was currently being weaned off ECMO support; APACHE II, SOFA score, and OSF number on the first day of ECMO support and the day of ECMO removal, respectively; AKIN stage (AKIN48-hour) at 48 hours post-ECMO removal; duration of hospitalization; and outcome
Summary
Extracorporeal membrane oxygenation (ECMO) has been utilized in critically ill patients such as those with severe, reversible myocardial dysfunction and life-threatening respiratory failure. Independent prognostic factors and outcome scoring systems for predicting hospital mortality for patients on the first day of ECMO support [2] and those already on ECMO support [3] have been elucidated. To date no study has clarified the relationship between patients being weaned from ECMO support and their short term prognosis. This study investigated the prognostic factors and compared the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II [4], Sequential Organ Failure Assessment (SOFA) [5], Organ System Failure (OSF) number [6], and Acute Kidney Injury Network (AKIN) stages [7] for predicting hospital mortality and short-term prognosis in patients being weaned from ECMO support
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