Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study

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• 作者：Hussein D. Kanji ; MD ; MSc ; MPH ; FRCPC^a ; ^b ; ^f ; ^{hdkanji@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Jessica McCallum ; BSc^c ; Monica Norena ; MSc^d ; Hubert Wong ; PhD^d ; Donald E. Griesdale ; MD ; MPH ; FRCPC^b ; ^f ; Steven Reynolds ; MD ; FRCPC^a ; ^b ; George Isac ; MD ; FRCPC^b ; ^f ; Demetrios Sirounis ; MD ; FRCPC^b ; ^e ; Derek Gunning ; MD ; FRCPS^a ; ^b ; Gordon Finlayson ; MD ; FRCPC^b ; ^f ; Peter Dodek ; MD ; MHSc ; FRCPC^b ; ^d
• 关键词：Extracorporeal membrane oxygenation ; Acute respiratory distress syndrome ; Respiratory failure ; Critical care
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：33
• 期：Complete
• 页码：169-173
• 全文大小：279 K

文摘

The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Paclass="smallcaps">o₂/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.