Sun Kyun Ro1, Wan Kee Kim2, Ju Yong Lim2, Jae Suk Yoo3, Sang-Bum Hong4, Joon Bum Kim5. 1. Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 2. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 3. Department of Thoracic and Cardiovascular Surgery, Sejong Hospital, Buchoen, South Korea. 4. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 5. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: jbkim1975@amc.seoul.kr.
Abstract
OBJECTIVE: Although the use of extracorporeal membrane oxygenation (ECMO) in shock patients is increasing worldwide, studies concerning this treatment for adult septic shock are limited. This study aimed to analyze the outcome of venoarterial ECMO in adult patients with septic shock refractory to conventional treatment. METHODS: A total of 71 consecutive patients who presented with septic shock and underwent venoarterial ECMO were reviewed. Clinical parameters were compared between survivors and nonsurvivors. Weaning and survival outcomes of these patients were compared with the control group of 253 patients who received venoarterial ECMO for cardiogenic shock. RESULTS: The mean age was 56.0 ± 12.3 years. Of the 71 septic shock patients, 11 (15.5%) were successfully weaned from ECMO after a median of 7.9 [interquartile range (IQR), 6.3-10.2] days, 5 of whom (7.0%) survived to discharge. Pre- and 6 hours post-procedural lactate levels were significantly higher in the nonsurvivors (11.6 [IQR, 7.5-15.0] vs 5.8 [IQR, 4.3-5.9], P = .036; 15.0 [IQR, 11.1-15.0] vs 5.2 [IQR, 4.7-5.4], P = .002). Rates of successful weaning from venoarterial ECMO (15.5% vs 45.5%), and of survival up to hospital discharge (7.0% vs 28.9%) were significantly lower in septic shock than in cardiogenic shock patients (n = 253; P < .001). CONCLUSIONS: Outcomes of ECMO in refractory septic shock patients were poor with a very low probability of survival. This finding raises questions concerning the utility of applying ECMO for medically refractory septic shock. Elevated arterial lactate levels pre- and post-ECMO were associated with risk of in-hospital death. Further large-scale studies are needed to validate the results of this study.
OBJECTIVE: Although the use of extracorporeal membrane oxygenation (ECMO) in shockpatients is increasing worldwide, studies concerning this treatment for adult septic shock are limited. This study aimed to analyze the outcome of venoarterial ECMO in adult patients with septic shock refractory to conventional treatment. METHODS: A total of 71 consecutive patients who presented with septic shock and underwent venoarterial ECMO were reviewed. Clinical parameters were compared between survivors and nonsurvivors. Weaning and survival outcomes of these patients were compared with the control group of 253 patients who received venoarterial ECMO for cardiogenic shock. RESULTS: The mean age was 56.0 ± 12.3 years. Of the 71 septic shockpatients, 11 (15.5%) were successfully weaned from ECMO after a median of 7.9 [interquartile range (IQR), 6.3-10.2] days, 5 of whom (7.0%) survived to discharge. Pre- and 6 hours post-procedural lactate levels were significantly higher in the nonsurvivors (11.6 [IQR, 7.5-15.0] vs 5.8 [IQR, 4.3-5.9], P = .036; 15.0 [IQR, 11.1-15.0] vs 5.2 [IQR, 4.7-5.4], P = .002). Rates of successful weaning from venoarterial ECMO (15.5% vs 45.5%), and of survival up to hospital discharge (7.0% vs 28.9%) were significantly lower in septic shock than in cardiogenic shockpatients (n = 253; P < .001). CONCLUSIONS: Outcomes of ECMO in refractory septic shockpatients were poor with a very low probability of survival. This finding raises questions concerning the utility of applying ECMO for medically refractory septic shock. Elevated arterial lactate levels pre- and post-ECMO were associated with risk of in-hospital death. Further large-scale studies are needed to validate the results of this study.