Laura C Myers1, Charlotte Lee2, B Taylor Thompson1, Gaston Cudemus3, Yuval Raz1, Nathalie Roy4. 1. Harvard Medical School, Boston, MA; Division of Pulmonary/Critical Care, Department of Medicine. 2. Harvard Medical School, Boston, MA; Department of Medicine. 3. Harvard Medical School, Boston, MA; Department of Anesthesia. 4. Harvard Medical School, Boston, MA; Department of Cardiac Surgery, now at Boston Children's Hospital, Boston MA. Electronic address: nathalie.roy@cardio.chboston.org.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been shown to provide benefits in children with septic shock, but not adults. We describe the clinical outcomes of adults who received ECMO in septic shock. METHODS: We retrospectively studied adults supported on veno-arterial or veno-venous modes of ECMO with septic shock at the time of cannulation from 1/1/2009-12/31/2016 at a quaternary medical center in the United States. The primary outcome was rate of survival to hospital discharge and time to survival using Kaplan-Meier survival estimates. We analyzed survival by mode, previous cardiac arrest and timing of cannulation (<96 and ≥96 hours after admission to the intensive care unit). Secondary outcomes were complications and days of ECMO support, length of stay in the intensive care unit, and hospitalization days. RESULTS: Of 243 patients supported on ECMO during this 7-year period, 32 met the criteria for septic shock and the majority had a pulmonary source of infection (72%). The most common mode of support was VV ECMO (65%) and median ejection fraction was 51%. Median time on ECMO was 5.8 days (IQR 2.6, 11.3). Survival to hospital discharge was 13 of 32 (41%) while median survival was 14.5 days (5.2, 23.7). There was no statistically significant difference in survival by subgroup, including ECMO mode. Healthcare associated infections were frequent (25%). CONCLUSIONS: Our cohort of patients receiving ECMO had equivalent median survival compared to literature-based estimates of other cohorts of patients with septic shock.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been shown to provide benefits in children with septic shock, but not adults. We describe the clinical outcomes of adults who received ECMO in septic shock. METHODS: We retrospectively studied adults supported on veno-arterial or veno-venous modes of ECMO with septic shock at the time of cannulation from 1/1/2009-12/31/2016 at a quaternary medical center in the United States. The primary outcome was rate of survival to hospital discharge and time to survival using Kaplan-Meier survival estimates. We analyzed survival by mode, previous cardiac arrest and timing of cannulation (<96 and ≥96 hours after admission to the intensive care unit). Secondary outcomes were complications and days of ECMO support, length of stay in the intensive care unit, and hospitalization days. RESULTS: Of 243 patients supported on ECMO during this 7-year period, 32 met the criteria for septic shock and the majority had a pulmonary source of infection (72%). The most common mode of support was VV ECMO (65%) and median ejection fraction was 51%. Median time on ECMO was 5.8 days (IQR 2.6, 11.3). Survival to hospital discharge was 13 of 32 (41%) while median survival was 14.5 days (5.2, 23.7). There was no statistically significant difference in survival by subgroup, including ECMO mode. Healthcare associated infections were frequent (25%). CONCLUSIONS: Our cohort of patients receiving ECMO had equivalent median survival compared to literature-based estimates of other cohorts of patients with septic shock.
Authors: Martin Stenlo; Iran A N Silva; Snejana Hyllén; Deniz A Bölükbas; Anna Niroomand; Edgars Grins; Per Ederoth; Oskar Hallgren; Leif Pierre; Darcy E Wagner; Sandra Lindstedt Journal: Physiol Rep Date: 2021-07