Improvement in the survival rates of extracorporeal membrane oxygenation-supported respiratory failure patients: a multicenter retrospective study in Korean patients

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Abstract

Background

Although 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.

Methods

This 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.

Results

During 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.

Conclusions

Utilization 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.

Related collections

Most cited references 12

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Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome.

Andrew Davies, Daryl Jones, Michael Bailey … (2009)

The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO). To describe the characteristics of all patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes. An observational study of all patients (n = 68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival. Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1) (n = 53) or influenza A not subtyped (n = 8), representing an incidence rate of 2.6 ECMO cases per million population. An additional 133 patients with influenza A received mechanical ventilation but no ECMO in the same ICUs. The 68 patients who received ECMO had a median (interquartile range [IQR]) age of 34.4 (26.6-43.1) years and 34 patients (50%) were men. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a median (IQR) Pao(2)/fraction of inspired oxygen (Fio(2)) ratio of 56 (48-63), positive end-expiratory pressure of 18 (15-20) cm H(2)O, and an acute lung injury score of 3.8 (3.5-4.0). The median (IQR) duration of ECMO support was 10 (7-15) days. At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge, of whom 32 had survived to hospital discharge and 16 remained as hospital inpatients. Fourteen patients (21%; 95% CI, 11%-30%) had died and 6 remained in the ICU, 2 of whom were still receiving ECMO. During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A(H1N1)-associated respiratory failure, one-third of whom received ECMO. These ECMO-treated patients were often young adults with severe hypoxemia and had a 21% mortality rate at the end of the study period.

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Record: found
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Extracorporeal Life Support Organization Registry International Report 2016.

Ravi Thiagarajan, Steven A Conrad, Matthew L Paden … (2016)

Data on extracorporeal life support (ECLS) use and survival submitted to the Extracorporeal Life Support Organization's data registry from the inception of the registry in 1989 through July 1, 2016, are summarized in this report. The registry contained information on 78,397 ECLS patients with 58% survival to hospital discharge. Extracorporeal life support use and centers providing ECLS have increased worldwide. Extracorporeal life support use in the support of adults with respiratory and cardiac failure represented the largest growth in the recent time period. Extracorporeal life support indications are expanding, and it is increasingly being used to support cardiopulmonary resuscitation in children and adults. Adverse events during the course of ECLS are common and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams.

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Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score.

Matthieu Schmidt, Michael Bailey, Jayne Sheldrake … (2014)

Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Better prediction of survival in these patients may improve resource use, allow risk-adjusted comparison of center-specific outcomes, and help clinicians to target patients most likely to benefit from ECMO.

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Author and article information

Contributors

Moon Seong Baek: wido21@naver.com

Sang-Min Lee: sangmin2@snu.ac.kr

Chi Ryang Chung: ccrzzang@gmail.com

Woo Hyun Cho: popeyes0212@hanmail.net

Young-Jae Cho: lungdrcho@gmail.com

Sunghoon Park: f2000tj@naver.com

So-My Koo: koosomy@naver.com

Jae-Seung Jung: heartistcs@korea.ac.kr

Seung Yong Park: cough@jbnu.ac.kr

Youjin Chang: yjchang0110@gmail.com

Byung Ju Kang: pastnumber@hanmail.net

Jung-Hyun Kim: legio@naver.com

Jin Young Oh: indr71@hanmail.net

So Hee Park: sojjang01@gmail.com

Jung-Wan Yoo: chareok-sa@hanmail.net

Yun Su Sim: sysliver@naver.com

Sang-Bum Hong:

ORCID: http://orcid.org/0000-0003-2737-7695

82-2-3010-3893 , hongsangbum@gmail.com

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 3 January 2019

Publication date PMC-release: 3 January 2019

Publication date Collection: 2019

Volume: 23

Electronic Location Identifier: 1

Affiliations

[1 ]ISNI 0000 0001 0842 2126, GRID grid.413967.e, Department of Pulmonary and Critical Care Medicine, , Asan Medical Center, University of Ulsan College of Medicine, ; 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Republic of Korea

[2 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul National University College of Medicine, ; Seoul, Republic of Korea

[3 ]ISNI 0000 0001 0640 5613, GRID grid.414964.a, Department of Critical Care Medicine, , Samsung Medical Center, ; Seoul, Republic of Korea

[4 ]ISNI 0000 0004 0442 9883, GRID grid.412591.a, Department of Internal Medicine, , Pusan National University Yangsan Hospital, ; Yangsan-si, Gyeongsangnam-do Republic of Korea

[5 ]ISNI 0000 0004 0647 3378, GRID grid.412480.b, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul National University Bundang Hospital, ; Seongnam-si, Gyeonggi-do Republic of Korea

[6 ]ISNI 0000000404154154, GRID grid.488421.3, Division of Pulmonary and Critical Care Medicine, Department of Medicine, , Hallym University Sacred Heart Hospital, ; Anyang-si, Gyeonggi-do Republic of Korea

[7 ]ISNI 0000 0004 0634 1623, GRID grid.412678.e, Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, , Soonchunhyang University Hospital, ; Seoul, Republic of Korea

[8 ]Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

[9 ]ISNI 0000 0004 0647 1516, GRID grid.411551.5, Department of Internal Medicine, , Chonbuk National University Hospital, ; Jeonju-si, Jeollabuk-do Republic of Korea

[10 ]ISNI 0000 0004 0647 4151, GRID grid.411627.7, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Inje University College of Medicine, Sanggye Paik Hospital, ; Seoul, Republic of Korea

[11 ]ISNI 0000 0004 0647 7248, GRID grid.412830.c, Division of Pulmonology, Department of Internal Medicine, , Ulsan University Hospital, ; Ulsan, Republic of Korea

[12 ]ISNI 0000 0004 0570 1076, GRID grid.452398.1, Division of Pulmonary and Critical Care Medicine, Department of Medicine, , Bundang CHA Hospital, ; Seongnam-si, Gyeonggi-do Republic of Korea

[13 ]ISNI 0000 0004 1792 3864, GRID grid.470090.a, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Dongguk University, Ilsan Hospital, ; Goyang-si, Gyeonggi-do Republic of Korea

[14 ]ISNI 0000 0001 0357 1464, GRID grid.411231.4, Department of Pulmonary and Critical Care Medicine, , Kyung Hee University Hospital, ; Gangdong, Seoul, Republic of Korea

[15 ]ISNI 0000 0004 0624 2502, GRID grid.411899.c, Department of Internal Medicine, College of Medicine, , Gyeongsang National University Hospital, ; Jinju, Gyeonsangnam-do Republic of Korea

[16 ]GRID grid.477505.4, Division of Pulmonary and Critical Care Medicine, Department of Medicine, , Hallym University Kangnam Sacred Heart Hospital, ; Seoul, Republic of Korea

Author information

Sang-Bum Hong http://orcid.org/0000-0003-2737-7695

Article

Publisher ID: 2293

DOI: 10.1186/s13054-018-2293-5

PMC ID: 6318967

PubMed ID: 30606235

SO-VID: 381a5acd-4b11-414e-a92f-271ffdf59760

License:

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