Alex Warren1, Yi-Da Chiu2, Sofía S Villar3, Jo-Anne Fowles4, Nicola Symes5, Julian Barker6, Luigi Camporota7, Chris Harvey8, Stephane Ledot9, Ian Scott10, Alain Vuylsteke11. 1. Division of Anaesthesia, Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Critical Care Unit, Royal Papworth Hospital, Cambridge, UK. 2. MRC Biostatistics Unit, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Clinical Trials Unit, Royal Papworth Hospital, Cambridge, UK. 3. MRC Biostatistics Unit, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK. 4. Critical Care Unit, Royal Papworth Hospital, Cambridge, UK. 5. Highly Specialised Services, NHS England, London, UK. 6. Cardiothoracic Critical Care Unit, Wythenshawe Hospital, Manchester, UK. 7. Department of Critical Care, Guy's & St Thomas' Hospitals, London, UK; Division of Asthma, Allergy and Lung Biology, King's College London, London, UK. 8. University Hospitals of Leicester, Leicester, UK. 9. Adult Intensive Care Unit, Royal Brompton & Harefield Hospitals, London, UK. 10. Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, UK. 11. Critical Care Unit, Royal Papworth Hospital, Cambridge, UK. Electronic address: a.vuylsteke@nhs.net.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used to support adults with severe respiratory failure refractory to conventional measures. In 2011, NHS England commissioned a national service to provide ECMO to adults with refractory acute respiratory failure. Our aims were to characterise the patients admitted to the service, report their outcomes, and highlight characteristics potentially associated with survival. METHODS: An observational cohort study was conducted of all patients treated by the NHS England commissioned ECMO service between December 1, 2011 and December 31, 2017. Analysis was conducted according to a prespecified protocol (NCT: 03979222). Data are presented as median [inter-quartile range, IQR]. RESULTS: A total of 1205 patients were supported with ECMO during the study period; the majority (n=1150; 95%) had veno-venous ECMO alone. The survival rate at ECMO ICU discharge was 74% (n=887). Survivors had a lower median age (43 yr [32-52]), compared with non-survivors (49 y [39-60]). Increased severity of hypoxaemia at time of decision-to-cannulate was associated with a lower probability of survival: survivors had a median Sao2 of 90% (84-93%; median Pao2/Fio2, 9.4 kPa [7.7-12.6]), compared with non-survivors (Sao2 88% [80-92%]; Pao2/Fio2 ratio: 8.5 kPa [7.1-11.5]). Patients requiring ECMO because of asthma were more likely to survive (95% survival rate (95% CI, 91-99%), compared with a survival of 71% (95% CI, 69-74%) in patients with respiratory failure attributable to other diagnoses. CONCLUSION: A national ECMO service can achieve good short-term outcomes for patients with undifferentiated respiratory failure refractory to conventional management. CLINICAL TRIAL REGISTRATION: NCT03979222.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used to support adults with severe respiratory failure refractory to conventional measures. In 2011, NHS England commissioned a national service to provide ECMO to adults with refractory acute respiratory failure. Our aims were to characterise the patients admitted to the service, report their outcomes, and highlight characteristics potentially associated with survival. METHODS: An observational cohort study was conducted of all patients treated by the NHS England commissioned ECMO service between December 1, 2011 and December 31, 2017. Analysis was conducted according to a prespecified protocol (NCT: 03979222). Data are presented as median [inter-quartile range, IQR]. RESULTS: A total of 1205 patients were supported with ECMO during the study period; the majority (n=1150; 95%) had veno-venous ECMO alone. The survival rate at ECMO ICU discharge was 74% (n=887). Survivors had a lower median age (43 yr [32-52]), compared with non-survivors (49 y [39-60]). Increased severity of hypoxaemia at time of decision-to-cannulate was associated with a lower probability of survival: survivors had a median Sao2 of 90% (84-93%; median Pao2/Fio2, 9.4 kPa [7.7-12.6]), compared with non-survivors (Sao2 88% [80-92%]; Pao2/Fio2 ratio: 8.5 kPa [7.1-11.5]). Patients requiring ECMO because of asthma were more likely to survive (95% survival rate (95% CI, 91-99%), compared with a survival of 71% (95% CI, 69-74%) in patients with respiratory failure attributable to other diagnoses. CONCLUSION: A national ECMO service can achieve good short-term outcomes for patients with undifferentiated respiratory failure refractory to conventional management. CLINICAL TRIAL REGISTRATION: NCT03979222.
Authors: Luigi Camporota; Christopher Meadows; Stephane Ledot; Ian Scott; Christopher Harvey; Miguel Garcia; Alain Vuylsteke Journal: Lancet Respir Med Date: 2021-01-08 Impact factor: 30.700