Hussein D Kanji1, Jessica McCallum2, Monica Norena3, Hubert Wong3, Donald E Griesdale4, Steven Reynolds5, George Isac4, Demetrios Sirounis6, Derek Gunning5, Gordon Finlayson4, Peter Dodek7. 1. Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada. Electronic address: hdkanji@gmail.com. 2. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 3. Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 4. Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada. 5. Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. 6. Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Heart Centre, St Paul's Hospital, Vancouver, BC, Canada. 7. Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
Abstract
PURPOSE: The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Pao2/fraction of inspired oxygen <100) who received early veno-venous extracorporeal membrane oxygenation (ECMO) as an adjunct to mechanical ventilation, to those in patients who received conventional mechanical ventilation alone. MATERIALS AND METHODS: This is a multicenter, retrospective unmatched and matched cohort study of patients admitted between April 2006 and December 2013. Generalized logistic mixed-effects models and Cox proportional hazards models were used to determine the association between treatment with ECMO that was started within 3 days of intensive care unit (ICU) admission and ICU and hospital mortality and length of stay, respectively. RESULTS: A total of 2440 patients who had severe hypoxemic respiratory failure due to various etiologies were included, 46 who received early veno-venous ECMO and 2394 unmatched and 398 matched controls who received conventional ventilation alone. Compared to matched controls, ECMO was associated with a lower odds of ICU (odds ratio [95% confidence interval], 0.30 [0.13-0.67]) and inhospital death (odds ratio 0.30 [0.14-0.67]). In addition, ECMO was associated with longer times to discharge from ICU and hospital (hazard ratio, 0.42 [0.37-0.47] and 0.53 [0.38-0.73], respectively). CONCLUSIONS: In this observational study, use of early ECMO compared to conventional mechanical ventilation alone in patients who had severe hypoxemic respiratory failure was associated with a lower risk of mortality and a longer length of stay.
PURPOSE: The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Pao2/fraction of inspired oxygen <100) who received early veno-venous extracorporeal membrane oxygenation (ECMO) as an adjunct to mechanical ventilation, to those in patients who received conventional mechanical ventilation alone. MATERIALS AND METHODS: This is a multicenter, retrospective unmatched and matched cohort study of patients admitted between April 2006 and December 2013. Generalized logistic mixed-effects models and Cox proportional hazards models were used to determine the association between treatment with ECMO that was started within 3 days of intensive care unit (ICU) admission and ICU and hospital mortality and length of stay, respectively. RESULTS: A total of 2440 patients who had severe hypoxemic respiratory failure due to various etiologies were included, 46 who received early veno-venous ECMO and 2394 unmatched and 398 matched controls who received conventional ventilation alone. Compared to matched controls, ECMO was associated with a lower odds of ICU (odds ratio [95% confidence interval], 0.30 [0.13-0.67]) and inhospital death (odds ratio 0.30 [0.14-0.67]). In addition, ECMO was associated with longer times to discharge from ICU and hospital (hazard ratio, 0.42 [0.37-0.47] and 0.53 [0.38-0.73], respectively). CONCLUSIONS: In this observational study, use of early ECMO compared to conventional mechanical ventilation alone in patients who had severe hypoxemic respiratory failure was associated with a lower risk of mortality and a longer length of stay.
Authors: Soo Jin Na; Chi Ryang Chung; Hee Jung Choi; Yang Hyun Cho; Kiick Sung; Jeong Hoon Yang; Gee Young Suh; Kyeongman Jeon Journal: Ann Intensive Care Date: 2018-02-27 Impact factor: 6.925