Retrospective analysis of factors associated with outcome in veno-venous extra-corporeal membrane oxygenation

Background The outcome of Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in acute respiratory failure may be influenced by patient-related factors, center expertise and modalities of mechanical ventilation (MV) during ECMO. We determined, in a medium-size ECMO center in Switzerland, possi...

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Published in:BMC pulmonary medicine 2023-08, Vol.23 (1), p.1-12, Article 301
Main Authors: Orthmann, Thomas, Ltaief, Zied, Bonnemain, Jean, Kirsch, Matthias, Piquilloud, Lise, Liaudet, Lucas
Format: Article
Language:English
Subjects:
Acute respiratory distress syndrome
Acute respiratory failure
Asthma
Care and treatment
Comparative analysis
COVID-19
Development and progression
Driving pressure
Extracorporeal membrane oxygenation
Gas flow
Health aspects
Lung transplants
Mechanical ventilation
Mortality
Nitric oxide
Oxygenation
Patient outcomes
Patient positioning
Physicians
Pulmonology
Regression analysis
Respiratory insufficiency
Respiratory system
United Kingdom
Veno-venous extracorporeal membrane oxygenation
Ventilators
Weaning
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Summary:Background The outcome of Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in acute respiratory failure may be influenced by patient-related factors, center expertise and modalities of mechanical ventilation (MV) during ECMO. We determined, in a medium-size ECMO center in Switzerland, possible factors associated with mortality during VV-ECMO for acute respiratory failure of various etiologies. Methods We retrospectively analyzed all patients treated with VV-ECMO in our University Hospital from 2012 to 2019 (pre-COVID era). Demographic variables, severity scores, MV duration before ECMO, pre and on-ECMO arterial blood gases and respiratory variables were collected. The primary outcome was ICU mortality. Data were compared between survivors and non-survivors, and factors associated with mortality were assessed in univariate and multivariate analyses. Results Fifty-one patients (33 ARDS, 18 non-ARDS) were included. ICU survival was 49% (ARDS, 39%; non-ARDS 67%). In univariate analyses, a higher driving pressure (DP) at 24h and 48h on ECMO (whole population), longer MV duration before ECMO and higher DP at 24h on ECMO (ARDS patients), were associated with mortality. In multivariate analyses, ECMO indication, higher DP at 24h on ECMO and, in ARDS, longer MV duration before ECMO, were independently associated with mortality. Conclusions DP on ECMO and longer MV duration before ECMO (in ARDS) are major, and potentially modifiable, factors influencing outcome during VV-ECMO. Keywords: Veno-venous extracorporeal membrane oxygenation, Acute respiratory failure, Acute respiratory distress syndrome, Mechanical ventilation, Driving pressure
ISSN:1471-2466
1471-2466
DOI:10.1186/s12890-023-02591-5