PMID- 28264702
OWN - NLM
STAT- MEDLINE
DCOM- 20180904
LR  - 20181113
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 21
IP  - 1
DP  - 2017 Mar 6
TI  - Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an 
      analysis of the Extracorporeal Life Support Organization (ELSO) registry.
PG  - 45
LID - 10.1186/s13054-017-1633-1 [doi]
LID - 45
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an 
      effective rescue therapy for severe cardiorespiratory failure, but morbidity and 
      mortality are high. We hypothesised that survival decreases with longer VA ECMO 
      treatment. We examined the Extracorporeal Life Support Organization (ELSO) 
      registry for a relationship between VA ECMO duration and in-hospital mortality, 
      and covariates including indication for support. METHODS: All VA runs from the 
      ELSO database from 2002 to 2012 were extracted. Multiple runs and non-VA runs 
      were excluded. Runs were categorized into diagnostic groups. Logistic regression 
      for analysis of the effect of duration on outcome, and multivariate regression 
      for diagnosis and other baseline factors were performed. Non-linear models 
      including piecewise logistic models were fitted. RESULTS: There were 2699 runs 
      analysed over 14,747 days. Logistic regression analysis of the effect of duration 
      on outcome, and multivariate regression analysis of diagnosis and other baseline 
      factors were performed. In-hospital survival was 41.4% (95% CI 39.6-43.3). 75% of 
      patients were supported for less than 1 week and 96% for less than 3 weeks. 
      Median duration (4 days IQR 2.0-6.8) was greater in survivors (4.1 (IQR 2.5-6.7) 
      vs 3.8 (IQR 1.7-7.0) p = 0.002). The final multivariate model demonstrated 
      increasing survival to day 4 (OR 1.53 (95% CI 1.37-1.71) p < 0.001), decreasing 
      from day 4 to 12 (OR 0.86 (95% CI 0.81-0.91), p < 0.001) with no significant 
      change thereafter (OR 0.98 (95% CI 0.94-1.02), p = 0.400). CONCLUSIONS: ECMO for 
      4 days or less is associated with higher mortality, likely reflecting early 
      treatment failure. Survival is highest when patients are weaned on the fourth day 
      of ECMO but likely decreases into the second week. While this does not suggest 
      weaning at this point will produce better outcomes, it does reflect the likely 
      time course of ECMO as a bridge in severe shock. Patients with some underlying 
      conditions (like myocarditis and heart transplantation) achieve better outcomes 
      despite longer support duration. These findings merit prospective study for the 
      development of prognostic models and weaning strategies.
FAU - Smith, Myles
AU  - Smith M
AUID- ORCID: 0000-0002-9308-2230
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia. myles.smith@unswalumni.com.
FAU - Vukomanovic, Alexander
AU  - Vukomanovic A
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia.
FAU - Brodie, Daniel
AU  - Brodie D
AD  - Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI, USA.
AD  - Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NW, 
      USA.
FAU - Thiagarajan, Ravi
AU  - Thiagarajan R
AD  - Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI, USA.
FAU - Rycus, Peter
AU  - Rycus P
AD  - Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI, USA.
FAU - Buscher, Hergen
AU  - Buscher H
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia.
AD  - Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI, USA.
AD  - University of New South Wales, Sydney, NSW, Australia.
LA  - eng
PT  - Journal Article
DEP - 20170306
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
CIN - Crit Care. 2017 Aug 1;21(1):203. PMID: 28764805
MH  - Adult
MH  - Extracorporeal Membrane Oxygenation/*methods/mortality/*standards
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Registries/statistics & numerical data
MH  - Retrospective Studies
MH  - *Time Factors
MH  - Treatment Outcome
PMC - PMC5339999
OTO - NOTNLM
OT  - Extracorporeal Life Support Organization
OT  - Extracorporeal membrane oxygenation
OT  - Outcomes
OT  - Refractory shock
OT  - Survival
OT  - Treatment duration
EDAT- 2017/03/08 06:00
MHDA- 2018/09/05 06:00
PMCR- 2017/03/06
CRDT- 2017/03/08 06:00
PHST- 2016/10/14 00:00 [received]
PHST- 2017/02/13 00:00 [accepted]
PHST- 2017/03/08 06:00 [entrez]
PHST- 2017/03/08 06:00 [pubmed]
PHST- 2018/09/05 06:00 [medline]
PHST- 2017/03/06 00:00 [pmc-release]
AID - 10.1186/s13054-017-1633-1 [pii]
AID - 1633 [pii]
AID - 10.1186/s13054-017-1633-1 [doi]
PST - epublish
SO  - Crit Care. 2017 Mar 6;21(1):45. doi: 10.1186/s13054-017-1633-1.