[Outcome of extracorporeal membrane oxygenation support for adult patients in Fuwai Hospital during the last 10 years: treatment strategy and risk factors]

Gao Guodong, Lyu Lin, Hu Qiang, Hu Jinxiao, Hei Feilong, Ji Bingyan, Liu jinping, Yu Kun, Long Cun
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015, 27 (12): 959-64

OBJECTIVE: To retrospectively review the clinical data of patients receiving extracorporeal membrane oxygenation (ECMO) during the last 10 years in Fuwai Hospital in order to assess the factors associated with the outcome of patients who had undergone ECMO, as well as to summarize the clinical experience, and to adopt a treatment strategy for future clinical decision.

METHODS: The clinical data of adult patients undergoing ECMO admitted to Fuwai Hospital from December 2004 to December 2014 were retrospectively analyzed. Demographic characteristics, diagnosis, ECMO related data, including ECMO indication, operation, undergoing cardiopulmonary resuscitation (CPR) or not, and site of establishment, clinical parameters before and 24 hours after ECMO, duration of ECMO, and complications were collected to set up a database. The patients were divided into survival group and non-survival group according to the prognosis. The risk factors of mortality in hospital after ECMO were analyzed by logistic regression. RESULTS There were 142 adult patients who had received ECMO support, with 106 male and 36 female. All patients received veno-arterial ECMO (V-A ECMO). The indication of ECMO in 59 patients was unsuccessful weaning from extracorporeal circulation (41.5%), and that of 44 patients was low cardiac output cardiogenic shock (31.0%). CPR was necessary in 34 out of 142 patients undergoing ECMO. In 37 patients intra-aortic balloon pump (IABP) was necessary. ECMO was successfully weaned in 99 patients (69.7%), and 84 patients (59.2%) survived. The most frequent complication during ECMO support was bleeding from site of catheterization or operation (45.8%). Logistic regression revealed that high lactic acid levels [odds ratio (OR) = 1.469, 95% confidence interval (95%CI) = 1.170-1.843, P = 0.001] and high blood glucose (OR = 0.984, 95%CI = 0.969-0.999, P = 0.037) at 24 hours after ECMO, multiple organ dysfunction syndrome (MODS, OR = 17.243, 95%CI = 3.177-93.581, P = 0.001), gastrointestinal bleeding (OR = 8.774, 95%CI = 1.414-54.457, P = 0.020) were risk factors of in-hospital mortality in adult patients undergoing ECMO.

CONCLUSIONS: ECMO can provide effective auxiliary support in patients with respiratory and circulatory failure, which 'shows good clinical effect. Strict indication, timely ECMO support and sophisticated management are the keys to the success of ECMO. The most frequent complications during ECMO support is bleeding from site of catheterization or operation. High lactic acid levels at 24 hours after ECMO, MODS and gastrointestinal bleeding are predictors of in-hospital mortality in adult patients, and appropriate control of blood sugar was beneficial for the recovery of patients.

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