scholarly journals Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support

2019 ◽  
Vol 13 ◽  
pp. 175346661984894 ◽  
Author(s):  
Soo Jin Na ◽  
Jae-Seung Jung ◽  
Sang-Bum Hong ◽  
Woo Hyun Cho ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Ecmo Support ◽  
Respiratory Support ◽  
Short Term ◽  
Membrane Oxygenation

Background: There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days. Methods: Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups. Results: A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4–20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses. Conclusions: Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.

Long-term outcomes of adults with acute respiratory failure treated with veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 0310057X2110423
Author(s):  
Emma L Gray ◽  
Paul Forrest ◽  
Timothy J Southwood ◽  
Richard J Totaro ◽  
Brian T Plunkett ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Respiratory Failure ◽  
Standard Deviation ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Body Mass ◽  
Multiple Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Retrospective Audit

Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning. A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m2), and mostly were male (59%). Most patients (60%) had no comorbidities. The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1–9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.

Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia

2017 ◽  
Vol 34 (4) ◽  
pp. 344-350 ◽  
Author(s):  
Roberto Roncon-Albuquerque ◽  
Rodrigo Vilares-Morgado ◽  
Gert-Jan van der Heijden ◽  
João Ferreira-Coimbra ◽  
Paulo Mergulhão ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Lung Protective Ventilation ◽  
Survival Prediction ◽  
High Survival ◽  
Membrane Oxygenation ◽  
Legionella Pneumonia

Objective: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. Design and Setting: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. Participants: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Results: Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2 ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to “lung rest” settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13). Conclusion: In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.

scholarly journals Efficacy of extracorporeal membrane oxygenation for acute respiratory failure with interstitial lung disease: a case control nationwide dataset study in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuko Usagawa ◽  
Kosaku Komiya ◽  
Mari Yamasue ◽  
Kiyohide Fushimi ◽  
Kazufumi Hiramatsu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Lung Disease ◽  
Case Control ◽  
Antifungal Drugs ◽  
Membrane Oxygenation

Abstract Background Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. Methods In this case–control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. Patients’ characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded. Results A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. Their in-hospital mortality was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio [OR] 1.043; 95% confidence interval [CI] 1.009–1.078), non-use of macrolides (OR 0.305; 95% CI 0.134–0.698), and use of antifungal drugs (OR 2.416; 95% CI 1.025–5.696). Conclusions Approximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

scholarly journals Efficacy of extracorporeal membrane oxygenation for acute respiratory failure with interstitial lung disease; a case control nationwide dataset study in Japan

2021 ◽  
Author(s):  
Yuko Usagawa ◽  
Kosaku Komiya ◽  
Mari Yamasue ◽  
Kiyohide Fushimi ◽  
Kazufumi Hiramatsu ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Lung Transplantation ◽  
Lung Disease ◽  
Case Control ◽  
Antifungal Drugs ◽  
Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. In-hospital mortality of them was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

scholarly journals Efficacy of Extracorporeal Membrane Oxygenation for Acute Respiratory Failure with Interstitial Lung Disease; A Case Control Nationwide Dataset Study in Japan

2021 ◽  
Author(s):  
Yuko Usagawa ◽  
Kosaku Komiya ◽  
Mari Yamasue ◽  
Kiyohide Fushimi ◽  
Kazufumi Hiramatsu ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Lung Transplantation ◽  
Lung Disease ◽  
Case Control ◽  
Antifungal Drugs ◽  
Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Study design and Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation for acute respiratory failure from 2010 to 2017. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included, 122 of whom (74.4%) died during hospitalization. Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

Clinical outcomes of immunocompromised patients on extracorporeal membrane oxygenation support for severe acute respiratory failure

2019 ◽  
Author(s):  
Soo Jin Na ◽  
So Hee Park ◽  
Sang-Bum Hong ◽  
Woo Hyun Cho ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Ecmo Support ◽  
Immunocompromised Patients ◽  
Membrane Oxygenation ◽  
Ventilatory Parameters ◽  
Successful Weaning ◽  
Immunocompromised Status ◽  
Immunocompetent Patients

Abstract OBJECTIVES There are limited data regarding extracorporeal membrane oxygenation (ECMO) support in immunocompromised patients, despite an increase in ECMO use in patients with respiratory failure. The aim of this study was to investigate the clinical characteristics and outcomes of immunocompromised patients requiring ECMO support for severe acute respiratory failure. METHODS Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into 2 groups based on the immunocompromised status at the time of ECMO initiation. In-hospital and 6-month mortalities were compared between the 2 groups. In addition, association of immunocompromised status with 6-month mortality was evaluated with logistic regression analysis. RESULTS Among 461 patients, 118 (25.6%) were immunocompromised. Immunocompromised patients were younger and had lower haemoglobin and platelet counts than immunocompetent patients. Ventilatory parameters and the use of adjunctive/rescue therapies were similar between the 2 groups, but prone positioning was more commonly used in immunocompetent patients. Successful weaning rates from ECMO (46.6% vs 58.9%; P = 0.021) was lower and hospital mortality (66.1% vs 59.8%; P = 0.22) was higher in immunocompromised patients. In addition, immunocompromised status was associated with higher 6-month mortality (74.6% vs 64.7%, adjusted odds ratio 2.10, 95% confidence interval 1.02–4.35; P = 0.045). CONCLUSIONS Immunocompromised patients treated with ECMO support for severe acute respiratory failure had poorer short- and long-term prognoses than did immunocompetent patients.

Sign in / Sign up

Export Citation Format

Share Document