Background
Methods
Study design
Data collection
Statistical analysis
Results
Baseline characteristics of the study population
Variable | Total (n = 487) |
---|---|
Age (years) | 58 (45, 66) |
Male | 321 (65.9) |
Body mass index (kg/m2) | 22.2 (20.6, 23.2) |
APACHE II score | 21 (15, 28) |
SOFA score | 8 (5, 12) |
PRESERVE score | 5 (4, 6) |
RESP score | 0 (−2, 2) |
Etiology of ARF | |
Viral pneumonia | 47 (9.7) |
Bacterial pneumonia | 127 (26.1) |
COPD and asthma | 8 (1.6) |
Trauma and burn | 25 (5.1) |
Asphyxia | 13 (2.7) |
Acute exacerbation of ILD | 61 (12.5) |
Chronic respiratory failure | 24 (4.9) |
ARDS | 44 (9.0) |
Airway obstruction | 28 (5.7) |
Other respiratory failure | 110 (22.6) |
Immunocompromiseda | 122 (25.2) |
CNS dysfunctionb | 24 (5.0) |
Vasopressor | 301 (63.0) |
Corticosteroid | 82 (16.8) |
Cardiac arrest | 74 (15.2) |
CRRT | 83 (17.0) |
Mechanical ventilation | 449 (92.2) |
Prone positioning | 143 (29.5) |
Pre-ECMO rescue therapy | |
Nitric oxide | 127 (26.2) |
Bicarbonate infusion | 53 (11.0) |
Neuromuscular blocker | 230 (45.4) |
Vital signs | |
MAP (mmHg) | 70 (58, 84) |
Heart rate (/min) | 112 (95, 128) |
Respiratory rate (/min) | 22 (18, 28) |
ECMO type | |
Veno-venous | 429 (88.1) |
Veno-arterial | 42 (8.6) |
Veno-arteriovenous | 14 (2.9) |
Other | 2 (0.4) |
Arterial blood gases | |
pH | 7.28 (7.17, 7.38) |
PaO2 (mmHg) | 61 (51, 76) |
PaCO2 (mmHg) | 51 (39, 65) |
HCO3− (mEq/L) | 23 (19, 29) |
SaO2 (%) | 88 (79, 93) |
Ventilation parameters | |
PaO2/FiO2 | 65 (53, 90) |
FiO2 | 100 (90, 100) |
PEEP (cmH2O) | 10 (6, 12) |
PIP (cmH2O) | 28 (24, 32) |
Tidal volume (ml/kg) | 7 (6, 9) |
Driving pressure (cmH2O) | 18 (15, 24) |
Minute ventilation (L/min) | 9.6 (7.4, 12.4) |
Interval MV–ECMO (days) | 1 (0, 5) |
ECMO duration (days) | 8 (4, 18) |
Hospital stay (days) | 35 (18, 61) |
Tracheostomy | 199 (41.8) |
Weaning rate | 278 (57.1) |
Survival rate | 189 (38.8) |
Demographics, pre-ECMO parameters, and outcomes over time
Variable | 2012 (n = 104) | 2013 (n = 100) | 2014 (n = 130) | 2015 (n = 153) | p value |
---|---|---|---|---|---|
Age (years) | 59 (49, 69) | 60 (45, 68) | 58 (43, 66) | 57 (45, 63) | 0.199 |
Male | 69 (66.3) | 71 (71.0) | 93 (71.5) | 88 (57.5) | 0.050 |
Body mass index (kg/m2) | 22.6 (20.4, 24.6) | 22.9 (19.7, 25.0) | 22.1 (21.0, 22.9) | 22.0 (20.5, 22.9) | 0.073 |
APACHE II score | 21 (16, 27) | 22 (16, 29) | 21 (15, 30) | 19 (14, 26) | 0.162 |
SOFA score | 8 (5, 12) | 8 (5, 11) | 8 (5, 12) | 8 (6, 12) | 0.842 |
PRESERVE score | 5 (4, 7) | 6 (4, 7) | 5 (3, 6) | 5 (3, 6) | 0.245 |
RESP score | 0 (−2, 2) | 0 (−2, 2) | 0 (−2, 2) | 1(−1, 3) | 0.497 |
Etiology of ARF | 0.001 | ||||
Viral pneumonia | 7 (6.7) | 8 (8.0) | 11 (8.5) | 21 (13.7) | |
Bacterial pneumonia | 33 (31.7) | 16 (16.0) | 37 (28.5) | 41 (26.8) | |
COPD and asthma | 1 (1.0) | 2 (2.0) | 4 (3.1) | 1 (0.7) | |
Trauma and burn | 1 (1.0) | 4 (4.0) | 10 (7.7) | 10 (6.5) | |
Asphyxia | 0 (0.0) | 3 (3.0) | 8 (6.2) | 2 (1.3) | |
Acute exacerbation of ILD | 8 (7.7) | 17 (17.0) | 13 (10.0) | 23 (15.0) | |
Chronic respiratory failure | 11 (10.6) | 4 (4.0) | 6 (4.6) | 3 (2.0) | |
ARDS | 13 (12.5) | 14 (14.0) | 7 (5.4) | 10 (6.5) | |
Airway obstruction | 10 (9.6) | 6 (6.0) | 4 (3.1) | 8 (5.2) | |
Other respiratory failure | 20 (19.2) | 26 (26.0) | 30 (23.1) | 34 (22.2) | |
Immunocompromiseda | 26 (25.2) | 21 (21.4) | 34 (26.2) | 41 (26.8) | 0.799 |
CNS dysfunctionb | 3 (2.9) | 3 (3.1) | 8 (6.2) | 10 (6.5) | 0.413 |
Vasopressor | 48 (46.2) | 59 (59.0) | 96 (75.6) | 98 (66.7) | < 0.001 |
Corticosteroid | 22 (21.2) | 21 (21.0) | 23 (17.7) | 16 (10.5) | 0.068 |
Cardiac arrest | 8 (7.7) | 19 (19.0) | 24 (18.5) | 23 (15.0) | 0.080 |
CRRT | 20 (19.2) | 19 (19.0) | 20 (15.4) | 24 (15.7) | 0.783 |
Mechanical ventilation | 94 (90.4) | 83 (83.0) | 125 (96.2) | 147 (96.1) | < 0.001 |
Prone positioning | 7 (6.8) | 3 (3.1) | 58 (44.6) | 75 (49.0) | < 0.001 |
Pre-ECMO rescue therapy | |||||
Nitric oxide | 29 (28.2) | 22 (22.4) | 42 (32.3) | 34 (22.2) | 0.197 |
Bicarbonate infusion | 11 (10.7) | 12 (12.2) | 14 (10.8) | 16 (10.5) | 0.975 |
Neuromuscular blocker | 29 (28.2) | 32 (32.7) | 80 (61.5) | 89 (58.2) | < 0.001 |
Variable | 2012 (n = 104) | 2013 (n = 100) | 2014 (n = 130) | 2015 (n = 153) | p value |
---|---|---|---|---|---|
Vital signs | |||||
MAP (mmHg) | 74 (62, 89) | 72 (59, 86) | 63 (56, 72) | 70 (57, 84) | 0.001 |
Heart rate (/min) | 112 (98, 125) | 116 (101, 131) | 107 (94, 125) | 112 (94, 129) | 0.462 |
Respiratory rate (/min) | 26 (20, 30) | 24 (20, 30) | 20 (16, 26) | 20 (16, 26) | < 0.001 |
ECMO type | 0.003 | ||||
Veno-venous | 96 (92.3) | 95 (95.0) | 113 (86.9) | 125 (81.7) | |
Veno-arterial | 4 (3.8) | 2 (2.0) | 11 (8.5) | 25 (16.3) | |
Veno-arteriovenous | 3 (2.9) | 2 (2.0) | 6 (4.6) | 3 (2.0) | |
Other | 1 (1.0) | 1 (1.0) | 0 (0.0) | 0 (0.0) | |
Arterial blood gases | |||||
pH | 7.31 (7.17, 7.43) | 7.25 (7.17, 7.36) | 7.26 (7.15, 7.37) | 7.29 (7.18, 7.38) | 0.081 |
PaO2 (mmHg) | 60 (52, 74) | 66 (56, 79) | 62 (50, 75) | 61 (46, 76) | 0.211 |
PaCO2 (mmHg) | 52 (40, 62) | 56 (41, 72) | 51 (39, 71) | 47 (36, 59) | 0.013 |
HCO3− (mEq/L) | 24.3 (21.1, 31.0) | 24.1 (19.9, 29.5) | 22.4 (18.1, 27.9) | 22.0 (18.2, 25.5) | 0.003 |
SaO2 (%) | 88 (83, 92) | 89 (85, 94) | 88 (79, 93) | 87 (75, 93) | 0.243 |
Ventilation parameters | |||||
PaO2/FiO2 | 62 (53, 80) | 72 (59, 96) | 65 (53, 90) | 65 (48, 97) | 0.131 |
FiO2 | 100 (100, 100) | 100 (90, 100) | 100 (80, 100) | 100 (80, 100) | 0.069 |
PEEP (cmH2O) | 10 (6, 12) | 8 (5, 12) | 10 (6, 10) | 10 (7, 12) | 0.119 |
PIP (cmH2O) | 28 (24, 33) | 30 (25, 34) | 28 (23, 33) | 28 (24, 31) | 0.382 |
Tidal volume (ml/kg) | 389 (298, 575) | 420 (321, 513) | 444 (340, 600) | 428 (299, 518) | 0.255 |
Driving pressure (cmH2O) | 18 (14, 24) | 20 (16, 25) | 18 (15, 23) | 18 (15, 21) | 0.077 |
Minute ventilation (L/min) | 10.9 (7.8, 14.6) | 9.6 (7.7, 12.7) | 9.5 (7.2, 12.2) | 9.3 (6.8, 12.0) | 0.035 |
Interval MV–ECMO (days) | 2 (0, 7) | 1 (0, 5) | 1 (0, 5) | 2 (0, 5) | 0.090 |
ECMO duration (days) | 7 (4, 14) | 8 (5, 22) | 8 (3, 13) | 7 (4, 24) | 0.305 |
Hospital stay (days) | 32 (17, 47) | 34 (19, 65) | 39 (18, 73) | 34 (17, 60) | 0.318 |
Tracheostomy | 32 (30.8) | 38 (38.0) | 61 (48.8) | 68 (46.3) | 0.023 |
Weaning rate | 56 (53.8) | 50 (50.0) | 86 (66.2) | 86 (56.2) | 0.075 |
Survival rate | 32 (30.8) | 35 (35.0) | 67 (51.5) | 55 (35.9) | 0.005 |
Factors associated with mortality in patients supported with ECMO
Variable | OR (95% CI) | p value | OR (95% CI) | p value |
---|---|---|---|---|
Age (years) | 1.043 (1.029, 1.056) | < 0.001 | 1.038 (1.022, 1.054) | < 0.001 |
Male | 0.720 (0.487, 1.064) | 0.099 | ||
Year | 0.645 (0.444, 0.939) | 0.022 | ||
Body mass index (kg/m2) | 0.982 (0.927, 1.040) | 0.527 | ||
APACHE II score | 1.032 (1.010, 1.054) | 0.004 | ||
SOFA score | 1.020 (0.978. 1.065) | 0.358 | ||
Immunocompromised | 1.335 (0.868, 2.054) | 0.188 | ||
CNS dysfunction | 1.274 (0.534, 3.038) | 0.585 | ||
Vasopressor | 1.254 (0.857, 1.836) | 0.243 | ||
Corticosteroid | 1.914 (1.130, 3.242) | 0.016 | 2.251 (1.153, 4.397) | 0.018 |
Cardiac arrest | 1.050 (0.630, 1.747) | 0.852 | ||
CRRT | 2.102 (1.233, 3.581) | 0.006 | 2.196 (1.135, 4.247) | 0.019 |
Prone positioning | 1.054 (0.705, 1.575) | 0.798 | ||
Nitric oxide | 1.853 (1.194, 2.875) | 0.006 | ||
Bicarbonate infusion | 1.521 (0.820, 2.820) | 0.183 | ||
Neuromuscular blocker | 1.186 (0.821, 1.711) | 0.363 | ||
VV ECMO mode | 0.810 (0.456, 1.439) | 0.472 | ||
pH | 0.800 (0.244, 2.618) | 0.712 | ||
PaO2 (mmHg) | 0.998 (0.993, 1.003) | 0.433 | ||
PaCO2 (mmHg) | 1.007 (0.999, 1.015) | 0.083 | ||
PaO2/FiO2 | 0.999 (0.996, 1.002) | 0.447 | ||
PEEP (cmH2O) | 0.968 (0.918, 1.020) | 0.219 | ||
PIP (cmH2O) | 1.070 (1.034, 1.107) | < 0.001 | ||
Tidal volume (ml/kg) | 0.999 (0.998, 1.000) | 0.175 | ||
Driving pressure (cmH2O) | 1.078 (1.039, 1.118) | < 0.001 | 1.072 (1.031, 1.114) | < 0.001 |
Minute ventilation (L/min) | 1.022 (0.969, 1.077) | 0.428 | ||
Interval MV–ECMO (days) | 1.024 (0.998, 1.050) | 0.068 | ||
ECMO duration (days) | 1.016 (1.003, 1.029) | 0.017 | 1.020 (1.003, 1.038) | 0.021 |