| Outcomes of patients on extracorporeal membrane oxygenation support in Fuwai Hospital:treatment strategy and risk factorsObjective:We reviewed an obtained extracorporeal membrane oxygenation (ECMO) database and patients’medical records between December 2004 and December 2014 in Fuwai Hospital in order to assess the factors associated with outcome of patients undergoing ECMO for further clinical strategy.Methods:We reviewed an obtained 10 years’ECMO database and patients’medical records between December 2004 and December 2014 in Fuwai Hospital. Demographic characteristics including diagnosis, ECMO indication, operation, CPR and locations, clinical parameters before and 24h after ECMO, blood products and complication were collected to set up a database. Due to differences of adults and children in physiological and disease types, therefore adult patients (≥15y) and non-adults patients (0y～15y) were analyzed respectively. Logistic regression identified risk factors of mortality in hospital. Moreover, we followed up discharged patients by telephone and survival was analyzed by Kaplan-Meier curves stratified with adults or children.Results:There were 239 patients, of who were 159 male patients and 80 female patients. All patients received venoarterial ECMO (VAECMO).There were 142 adult patients who received ECMO support,106 male patients and 36 female patients. The ECMO indication is primarily unweaning from extracorporeal circulation (41.5%) and following by low cardiac (31.0%). There were 34 patients needing Cardiopulmonary resuscitation (CPR),37 needing (intra-aortic ballon pump) IABP and 1 needing (left ventricular assist device) LVAD.99 (69.7%) cases were successful weaned from ECMO, and 84 patients (59.2%) were discharge. The most frequent complications during ECMO support is bleeding from site of catheterization or surgery (45.8%). Logistic regression identified that high lactic acid levels at 24h after ECMO, MODS, gastrointestinal bleeding are predictors of in-hospital mortality.84 discharged adult patients were followed up by telephone until December 31,2014. The follow-up rate is 83.3%.15 patients from 70 patients were dead from cardiac disease.There were 97 non-adult patients who received ECMO support,53male patients and 44 female patients. The ECMO indication is primarily unweaning from extracorporeal circulation (47.4%). There were 26 patients needing Cardiopulmonary resuscitation (CPR),2 needing IABP.63 (64.9%) cases were successful weaned from ECMO,55 patients (56.7%) were discharge. The most frequent complications during ECMO support is bleeding from site of catheterization or surgery (44.3%). Logistic regression identified that high lactic acid levels at 24h after ECMO, acute renal failure and hyperbilirubinemia are predictors of in-hospital mortality.55 discharged adult patients were followed up by telephone until December 31,2014. The follow-up rate is 81.8%.11 patients from 46 patients were dead from cardiac disease.Incidence of replacement of pulmonary membrane (P=0.020), MODS (P=0.044), pneumonedema (P=0.014) and hemolysis (P<0.001) are higher in non-adults group compared with adults group.Conclusions:ECMO can provide effective auxiliary support for patients with respiratory and circulatory failure, which has good clinical effect and high long-term survival rate. The most frequent complications during ECMO support is bleeding from site of catheterization or surgery. High lactic acid levels at 24h after ECMO, MODS and gastrointestinal bleeding are predictors of in-hospital mortality in adult patients. High lactic acid levels at 24h after ECMO, acute renal failure and hyperbilirubinemia are predictors of in-hospital mortality in non-adult patients. Effectiveness of ECMO is justified by the good long-term outcomes of hospital survivors. Intervention to reduce the ECMO complications in order to improve the survival rate needs further study.Outcomes of patients on extracorporeal membrane oxygenation support in Fuwai Hospital:comparison between first and last five yearsObjective:We reviewed an obtained extracorporeal membrane oxygenation (ECMO) database and patients’ medical records between December 2004 and December 2014 in Fuwai Hospital in order to assess the outcome of patients undergoing ECMO between first and last five years for further clinical strategy.Methods:We reviewed an obtained 10 years’ ECMO database and patients’ medical records between December 2004 and December 2014 in Fuwai Hospital. Patients were divided into first five years group and last five years group. Demographic characteristics including diagnosis, ECMO indication, operation, CPR and locations, clinical parameters before and 24h after ECMO, blood products and complication were collected to set up a database. Due to differences of adults and children in physiological and disease types, therefore adult patients (≥15y) and non-adults patients (0y～15y) were analyzed respectively.Results:A total of 239 patients were included in this study.149 patients were in first five years group,98 patients (65.8%) of which weaned from ECMO successfully and 82 (55.0%) of which were survived to discharge.90 patients were in last five years group,63 patients (70.0%) of which weaned from ECMO successfully and 57 (63.3 %) of which were survived to discharge.There were 142 adult patients who received ECMO support.88 patients were in first five years group,63 patients (71.6%) of which weaned from ECMO and 53 cases (60.2%) of which were discharged.54 patients were in last five years group,36 cases (66.7%) of which weaned from ECMO and 31 cases (57.4%) of which were discharged. There was no significant difference in duration of ECMO, weaning rate, survival discharge rate, demographic characteristic and diagnosis between the two groups. The ECMO indication in first five years group was primarily unweaning from extracorporeal circulation (43cases,48.9%). Locations to set up ECMO in first five years group were operating room (43cases,48.9%), medical ICU (14 cases,15.9%) and surgical ICU (31cases,35.2%). The ECMO indications in last five years group were primarily low cardiac output (34 cases,63.0%) and unweaning from extracorporeal circulation (16cases,29.6%). Locations to set up ECMO in last five years group were operating room (46 cases,85.2%). The volume of platelets transfusion in first five years group was significantly higher than in last five years group. Incidences of clots, oxygenator leakage, acute renal failure, MODS, DIC and hyperbilirubinemia in first five years group were significantly higher than in last five years group.There were 97 non-adult patients who received ECMO support.61 patients were in first five years group,35 patients (57.4%) of which weaned from ECMO and 29 cases (47.5%) of which were discharged.36 patients were in last five years group,27 cases (75.0%) of which weaned from ECMO and 26 cases (72.2%) of which were discharged. Survival discharge rate of first five years group was higher than last five years group significantly. The ECMO indication in first five years group was primarily unweaning from extracorporeal circulation (32 cases,52.4%). However, the ECMO indications in last five years group were primarily low cardiac output (18 cases,50.0%) and unweaning from extracorporeal circulation (13 cases,36.1%). The volume of blood transfusion in first five years group was significantly higher than in last five years group. Incidences of ECMO system replacement, acute renal failure, peritoneal dialysis, MODS, hyperbilirubinemia, pneumonedema, gastrointestinal bleeding and hemolysis in first five years group were significantly higher than in last five years group.Conclusions:With accumulating of clinical experience, ECMO can provide effective auxiliary support for patients with respiratory and circulatory failure, which has good clinical effect. Strict indications, timely ECMO support and positive prevention and treatment of complications are the key to the success of the ECMO. Intervention to reduce the ECMO complications in order to improve the survival rate needs further study. |
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