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The outcome of patients requiring multiple extracorporeal membrane oxygenation: how many runs of ECMO is reasonable?

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) has been proven effective in life support for patients with refractory cardiopulmonary failure. Deteriorating patients who have removed their first ECMO support and required second or more courses of ECMO support have rarely been discussed.

Methods and results

All the records of the patients who experienced at least 2 courses of ECMO during single admission were retrieved. Survival was defined as survival to discharge. Demographic data and clinical information were compared between survival and nonsurvival groups. There were 86 patients who received at least 2 courses of ECMO in the 20-year database, and 27 (31.3%) were <18 years old. Of them, 87.3% received 2 runs of ECMO, 10.4% 3 runs, and 2.3% 4 runs. Overall survival rate was 30.2%. The survival rate for patients with 2 runs of ECMO was 33.3% (25 out of 75), 11.1% (1 out of 9) for 3 runs, and 0% (0 out of 2) for 4 runs. Multivariate analysis revealed that only ARF with hemodialysis was the independent risk factor.

Conclusions

The decision to perform repeated ECMO implantation is a complex and difficult process. Despite the arguments debating the consumption of resources and increased complications, there are still nearly 1 out of 3 patients who will survive to discharge. More than 2 courses of ECMO may be carefully considered for further rescue.

Int J Artif Organs 2016; 39(6): 288 - 293

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ijao.5000511

Authors

Heng-Wen Chou, Te-I Chang, Chih-Hsien Wang, Nai-Kuan Chou, Nai-Hsin Chi, Shu-Chien Huang, I-Hui Wu, Chih-Yang Chan, Lee-Mei Ponge, Ya-Chen Wang, Yih-Sharng Chen

Article History

Disclosures

Financial support: The present study was partially supported by the National Science Council program, 102-2325-B-002-009, 100-2325-B-009, and 103-3011-P-002-010.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

Affiliations

  • Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan
  • Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei - Taiwan
  • Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei - Taiwan
  • Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei - Taiwan
  • Heng-Wen Chou and Te-I Chang contributed equally to this study.

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