Background
Methods
Patient cohorts
Statistical analysis
Results
Baseline patient characteristics
Variables | Total
N = 272 | Survivor
N = 227 | Non-survivor N = 45 |
p
|
---|---|---|---|---|
Age | 36.2 ± 13.4 | 34.7 ± 12.5 | 43.4 ± 15.8 | 0.001 |
Male, N (%) | 108 (39.7) | 93 (40.9) | 15 (33.3) | 0.356 |
Weight, kg | 88.0 ± 29.1 | 87.5 ± 28.9 | 90.9 ± 30.4 | 0.501 |
Pre-ECMO blood gasesa
| ||||
pH | 7.1 ± 0.2 | 7.1 ± 0.2 | 7.2 ± 0.2 | 0.045 |
PCO2, mmHg | 80.5 ± 50.6 | 81.1 ± 51.6 | 77.2 ± 45.5 | 0.638 |
PO2, mm Hg | 109.6 ± 113.9 | 113.0 ± 115.5 | 91.3 ± 104.2 | 0.289 |
HCO3
-, mmol/L | 29.0 ± 9.4 | 29.2 ± 9.4 | 27.8 ± 9.6 | 0.402 |
SaO2, % | 91.2 ± 10.1 | 92.3 ± 7.4 | 85.2 ± 17.3 | 0.030 |
Pre-ECMO ventilator setting | ||||
Rate, breaths/min | 19.0 ± 7.7 | 18.6 ± 7.4 | 21.4 ± 9.4 | 0.129 |
FiO2, % | 81.2 ± 23.0 | 80.2 ± 23.2 | 87.2 ± 21.1 | 0.105 |
PIP, cmH2O | 38.2 ± 11.1 | 38.1 ± 11.4 | 38.7 ± 9.1 | 0.798 |
PEEP, cmH2O | 8.3 ± 5.9 | 7.8 ± 5.9 | 11.5 ± 5.1 | 0.002 |
MAP, cmH2O | 21.4 ± 14.2 | 21.4 ± 15.1 | 21.3 ± 7.8 | 0.980 |
Driving pressure, cmH2O | 29.5 ± 12.9 | 29.9 ± 13.4 | 27.4 ± 9.5 | 0.363 |
ECMO details
Variables | Total
N = 272 | Survivor
N = 227 | Non-survivor
N = 45 |
p
|
---|---|---|---|---|
ECMO modea
| ||||
VV | 131 (50.4) | 110 (50.7) | 21 (48.8) | 0.824 |
VVDL | 113 (43.5) | 94 (43.3) | 19 (44.2) | 0.916 |
VV to VA | 3 (1.2) | 1 (0.5) | 2 (4.7) | 0.019 |
VA | 5 (1.9) | 5 (2.3) | 0 | 0.315 |
VVDL + V | 6 (2.3) | 5 (2.3) | 1 (2.3) | 0.993 |
Other | 2 (0.8) | 2 (9.2) | 0 | 0.527 |
Hours on ECMO | 176.4 ± 192.7 | 161.6 ± 172.1 | 257.2 ± 268.4 | 0.035 |
Post-ECMO ventilator settingb
| ||||
Rate, breaths/min | 11.3 ± 4.3 | 11.1 ± 4.2 | 12.7 ± 5.0 | 0.043 |
FiO2, % | 48.8 ± 19.0 | 47.4 ± 17.8 | 57.4 ± 23.6 | 0.025 |
PIP, cmH2O | 25.0 ± 7.8 | 24.3 ± 4.5 | 29.7 ± 8.3 | < 0.001 |
PEEP, cmH2O | 8.1 ± 4.5 | 7.9 ± 4.5 | 9.0 ± 4.0 | 0.195 |
MAP, cmH2O | 14.2 ± 10.0 | 14.2 ± 10.4 | 14.6 ± 6.2 | 0.866 |
Driving pressure, cmH2O | 16.8 ± 7.8 | 16.2 ± 7.8 | 21.1 ± 6.6 | 0.002 |
Complications and in-hospital mortality
Variables | Total
N = 272 | Survivor
N = 227 | Non-survivor
N = 45 |
p
|
---|---|---|---|---|
Mechanical | 67 (24.6) | 48 (21.1) | 19 (42.2) | 0.003 |
Oxygenator failure | 14 (5.1) | 7 (3.1) | 7 (15.6) | 0.001 |
Clots: oxygenator | 31 (11.4) | 26 (11.5) | 5 (11.1) | 0.947 |
Clots: other | 10 (3.7) | 6 (2.6) | 4 (8.9) | 0.042 |
Cannula problems | 12 (4.4) | 9 (4.0) | 3 (6.7) | 0.304 |
Total bleeding | 77 (28.3) | 52 (22.9) | 25 (55.6) | < 0.001 |
GI hemorrhage | 7 (2.6) | 5 (2.2) | 2 (4.4) | 0.386 |
Cannulation site bleeding | 37 (13.6) | 25 (11.0) | 12 (26.7) | 0.005 |
Surgical site bleeding | 23 (8.5) | 16 (7.0) | 7 (15.6) | 0.061 |
Pulmonary hemorrhage | 14 (5.1) | 7 (3.1) | 7 (15.6) | 0.001 |
Neurologic | 13 (4.8) | 9 (4.0) | 4 (8.9) | 0.157 |
Brain death | 6 (2.2) | 3 (1.3) | 3 (6.7) | 0.026 |
Seizures | 7 (2.6) | 6 (2.6) | 1 (2.2) | 0.871 |
Cerebral infarction | 8 (2.9) | 2 (0.9) | 6 (13.3) | < 0.001 |
Cerebral hemorrhage | 12 (4.4) | 7 (3.1) | 5 (11.1) | 0.017 |
Renal | 73 (26.8) | 55 (24.2) | 18 (40) | 0.029 |
Dialysis required | 54 (19.9) | 39 (17.2) | 15 (33.3) | 0.013 |
Cardiovascular | 71 (26.1) | 57 (25.1) | 14 (31.1) | 0.402 |
Infection culture proven | 45 (16.5) | 34 (15.0) | 11 (24.4) | 0.118 |
Pneumothorax requiring treatment | 14 (5.1) | 12 (5.3) | 2 (4.4) | 0.815 |
Metabolic | 61 (22.4) | 50 (22.0) | 11 (24.4) | 0.722 |
Limb ischemia | 7 (2.6) | 5 (2.2) | 2 (4.4) | 0.386 |
Total complication | 177 (65.1) | 138 (60.8) | 39 (86.7) | 0.001 |
Weaning success | 234 (86.7) | 227 (100) | 7 (15.6) | < 0.001 |
Differences between survivors and non-survivors
Factors associated with in-hospital mortality
Variables | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
OR (95% CI) |
p
| OR (95% CI) |
p
| |
Age | 1.05 (1.02–1.07) | < 0.001 | 1.05 (1.01–1.08) | 0.012 |
Mechanical complications | 2.73 (1.39–5.34) | 0.003 | ||
Bleeding | 4.21 (2.16–8.18) | < 0.001 | 2.97 (1.07–8.24) | 0.036 |
Dialysis | 2.41 (1.19–4.90) | 0.015 | ||
Pre-ECMO PEEPa, cmH2O | 1.10 (1.03–1.18) | 0.003 | 1.10 (1.01–1.20) | 0.027 |
Pre-ECMO pHa
| 7.57 (1.04–55.29) | 0.046 | ||
Post-ECMO Fio2b, % | 1.02 (1.01–1.04) | 0.006 | 1.03 (1.00–1.05) | 0.034 |
Post-ECMO PIPb, cmH2O | 1.08 (1.03–1.14) | 0.001 | ||
Post-ECMO driving pressureb, cmH2O | 1.08 (1.03–1.13) | 0.003 | 1.08 (1.02–1.15) | 0.011 |