Posluszny Joseph, Rycus Peter T, Bartlett Robert H, Engoren Milo, Haft Jonathan W, Lynch William R, Park Pauline K, Raghavendran Krishnan, Napolitano Lena M
*Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI †Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI ‡Department of Anesthesiology, University of Michigan, Ann Arbor, MI §Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI ¶Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg. 2016 Mar;263(3):573-81. doi: 10.1097/SLA.0000000000001176.
To examine the outcomes of prolonged (≥14 days) extracorporeal membrane oxygenation (P-ECMO) for adult severe respiratory failure and to assess characteristics associated with survival.
The use of ECMO for treatment of severe respiratory adult patients is associated with overall survival rates of 50% to 70% with median ECMO duration of 10 days. No prior multi-institutional studies have examined outcomes of P-ECMO for severe respiratory failure.
Data on all adult (≥18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 were extracted from the Extracorporeal Life Support Organization international multi-institutional registry. We examined outcomes over 23 years and compared the 2 more recent time periods of 1989 to 2006 versus 2007 to 2013.
Up to 974 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range: 14-208 days). Venovenous ECMO support was most common (venovenous: 79.5%, venoarterial: 9.9%). Reason for ECMO discontinuation included native lung recovery (54%), organ failure (23.7%), family request (6.7%), hemorrhage (2.7%), and diagnosis incompatible with life (5.6%). Forty patients (4.1%) underwent lung transplant with 50% postoperative in-hospital mortality. Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported since 2008. Survival to hospital discharge was 45.4% (443/974) and did not vary with ECMO duration. Multivariate logistic regression analysis confirmed that P-ECMO patients 2007 to 2013 had a lower risk of death [odds ratio (OR): 0.650; 95% confidence interval (CI), 0.454-0.929; P = 0.010] compared with 1989 to 2006. Factors independently associated with survival were younger age (OR: 0.983; 95% CI, 0.974-0.993; P < 0.001) and lower PaCO2 (OR, 0.991; 95% CI, 0.986-0.996; P < 0.001).
Prolonged ECMO use for adult respiratory failure was associated with a lower (45.4%) hospital survival rate, compared with prior reported survival rates of short duration ECMO. Prolonged ECMO survival significantly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the 1989 to 2013 study cohort. Although P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified.
探讨成人严重呼吸衰竭患者延长（≥14天）体外膜肺氧合（P-ECMO）治疗的效果，并评估与生存相关的特征。
使用ECMO治疗成年重症呼吸患者的总体生存率为50%至70%，ECMO的中位持续时间为10天。此前尚无多机构研究探讨P-ECMO治疗严重呼吸衰竭的效果。
从体外生命支持组织国际多机构注册中心提取1989年至2013年所有因严重呼吸衰竭需要P-ECMO的成年（≥18岁）患者的数据。我们研究了23年期间的治疗效果，并比较了1989年至2006年与2007年至2013年这两个更近的时间段。
共有974例患者，平均年龄40.2岁（18 - 83岁），ECMO平均持续时间为25.2天/中位时间21.0天（范围：14 - 208天）。静脉 - 静脉ECMO支持最为常见（静脉 - 静脉：79.5%，静脉 - 动脉：9.9%）。ECMO撤机原因包括自身肺功能恢复（54%）、器官衰竭（23.7%）、家属要求（6.7%）、出血（2.7%）以及诊断为不治之症（5.6%）。40例患者（4.1%）接受了肺移植，术后院内死亡率为50%。自2008年以来，P-ECMO的病例报告患病率有所增加，占所有病例的72%（701/974）。出院生存率为45.4%（443/974），且与ECMO持续时间无关。多因素逻辑回归分析证实，与1989年至2006年相比，2007年至2013年接受P-ECMO治疗的患者死亡风险较低[比值比（OR）：0.650；95%置信区间（CI），0.454 - 0.929；P = 0.010]。与生存独立相关的因素为年龄较小（OR：0.983；95% CI，0.974 - 0.993；P < 0.001）和较低的动脉血二氧化碳分压（PaCO2）（OR，0.991；95% CI，0.986 - 0.996；P < 0.001）。
与先前报道的短期ECMO生存率相比，成人呼吸衰竭患者延长使用ECMO的出院生存率较低（45.4%）。近年来，延长ECMO治疗后的生存率显著提高，且在1989年至2013年的研究队列中，延长ECMO持续时间并未改变生存比例。尽管P-ECMO的生存率低于短期ECMO治疗，但P-ECMO支持是合理的。
