Mendiratta Priya, Tang Xinyu, Collins Ronnie T, Rycus Peter, Brogan Thomas V, Prodhan Parthak
From the *Department of Geriatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; ‡Division of Cardiology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; †Divisions of Biostatistics and Critical Care, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; §Extracorporeal Life Support Organization, Ann Arbor, Michigan; and ¶Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington.
ASAIO J. 2014 Jul-Aug;60(4):385-90. doi: 10.1097/MAT.0000000000000090.
Extracorporeal membrane oxygenation (ECMO) support among adults is increasing; however, the role in respiratory failure in the elderly is not clearly defined. The aim of the current study is to investigate survival to hospital discharge among the elderly supported on ECMO. The Extracorporeal Life Support Organization registry database was queried, identifying all elderly patients (≥65 years of age) supported on ECMO for respiratory failure from 1990 to May 2013. The primary outcome was survival to hospital discharge. Clinical characteristics between survivors and nonsurvivors were compared. A total of 368 elderly patients treated with ECMO support for respiratory failure were identified. The median admit-to-initiation-of-ECMO time was 24.5 hours, and median duration of ECMO was 140 hours. Survival at hospital discharge was 41%. Approximately 69% of the overall ECMO usages occurred from 2010 to 2013. Nonsurvivors had significantly higher pre-ECMO peak inspiratory pressures, lower SaO2/FiO2 ratio, and higher rate of diverse complications. Among pre-ECMO therapies, vasodilators, steroids, and inhaled nitric oxide were more frequently used in survivors. Survival-to-hospital discharge rate is lower (41%) in elderly patients treated with ECMO compared with that in all adults (55%). However, given the noted survival, age should not be a firm contraindication for the use of ECMO in older patients but should be considered on a case-by-case basis.
成人体外膜肺氧合（ECMO）支持的应用正在增加；然而，其在老年患者呼吸衰竭中的作用尚未明确界定。本研究的目的是调查接受ECMO支持的老年患者的出院生存率。查询了体外生命支持组织注册数据库，确定了1990年至2013年5月期间所有接受ECMO支持治疗呼吸衰竭的老年患者（≥65岁）。主要结局是出院生存率。比较了幸存者和非幸存者的临床特征。共确定了368例接受ECMO支持治疗呼吸衰竭的老年患者。从入院到开始使用ECMO 的中位时间为24.5小时，ECMO的中位持续时间为140小时。出院生存率为41%。ECMO的总体使用中约69%发生在2010年至2013年。非幸存者在使用ECMO前的吸气峰压显著更高，氧合指数（SaO2/FiO2）更低，且各种并发症的发生率更高。在使用ECMO前的治疗中，血管扩张剂、类固醇和吸入一氧化氮在幸存者中使用更为频繁。与所有成人（55%）相比，接受ECMO治疗的老年患者出院生存率较低（41%）。然而，鉴于已观察到的生存率，年龄不应成为老年患者使用ECMO的绝对禁忌证，而应根据具体情况进行考虑。
