Prognosis After Seven Days of Veno-Venous Extracorporeal Membrane Oxygenation Support.

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2025-06-03 DOI:10.1111/aor.15032

Felix A Rottmann, Rebecca Book, Alexander Supady, Viviane Zotzmann, Markus Jäckel, Alexander Maier, Frederic Arnold, Dirk Westermann, Tobias Wengenmayer, Jonathan Rilinger, Dawid L Staudacher

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引用次数: 0

Abstract

Background: Prognostication in patients receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) remains challenging, particularly during prolonged support. Accurate prognostic indicators are essential for patients, caregivers, and clinicians. This study evaluates outcomes in patients supported with V-V ECMO for at least seven days.

Methods: We conducted a single-center retrospective cohort study of patients cannulated for V-V ECMO due to respiratory failure. The primary endpoint was hospital survival. The subgroup of patients still on V-V ECMO on day 7, stratified by respirator and ECMO parameters, was analyzed with respect to predictors of the primary outcome. A survival favorability margin was defined as the bound of the hospital survivors' 95% confidence interval closest to the non-survivor median.

Results: Among 299 patients treated with V-V ECMO (median age 55 years, 66.9% male), hospital survival was 44.8%. Pneumonia was the primary cause of respiratory failure in 216 patients (72.2%). By day 7, 182/299 patients (60.9%) remained on V-V ECMO, with a hospital survival rate of 45.1%. Three respiratory parameters (ventilator FiO₂, tidal volume, compliance) and three V-V ECMO parameters (blood flow, sweep gas flow, O₂ fraction) significantly predicted hospital survival (all p ≤ 0.015). All six predictors separated survivors and non-survivors through day 1 to 10 (all p < 0.001). Moreover, the clustering of several parameters above the favorability margin showed a clear discrimination of the overall survival (≥ 5 vs. zero parameters, survival 67.5% vs. 13.8%, OR 13.0, 95% CI 3.5-38.6, p < 0.001).

Conclusion: Among patients still on V-V ECMO on day seven, respiratory and ECMO parameters above the favorability margin correlated strongly with hospital survival. Survival was rare in patients with all predictors below the favorability margin. Day seven could provide a useful, though not definitive, time point for prognostication based on respiratory and ECMO parameters.

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静脉-静脉体外膜氧合支持7天后的预后。

背景：接受静脉-静脉体外膜氧合（V-V ECMO）的患者的预后仍然具有挑战性，特别是在长时间支持期间。准确的预后指标对患者、护理人员和临床医生至关重要。这项研究评估了V-V ECMO支持至少7天的患者的结果。方法：我们对因呼吸衰竭而插管进行V-V ECMO的患者进行了单中心回顾性队列研究。主要终点是医院生存。对第7天仍使用V-V ECMO的患者亚组，按呼吸器和ECMO参数分层，分析主要结局的预测因素。生存有利度边际定义为医院幸存者的95%置信区间最接近非幸存者中位数的界限。结果：299例接受V-V ECMO治疗的患者（中位年龄55岁，66.9%为男性），住院生存率为44.8%。肺炎是216例（72.2%）患者呼吸衰竭的主要原因。到第7天，299例患者中有182例（60.9%）继续使用V-V ECMO，医院生存率为45.1%。3个呼吸参数（呼吸机FiO2、潮气量、顺应性）和3个V-V ECMO参数（血流量、扫气量、O2分数）对医院生存有显著预测作用（p均≤0.015）。所有6个预测指标在第1天至第10天将幸存者和非幸存者分开（均p）。结论：在第7天仍在V-V ECMO的患者中，高于有利范围的呼吸和ECMO参数与医院生存率密切相关。所有预测指标均低于有利范围的患者的生存率很低。第7天可以提供一个有用的，但不是确定的，基于呼吸和ECMO参数的预测时间点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.