Outcomes of Extracorporeal Membrane Oxygenation in Patients With Blood Culture Positive Septic

Abstract

Extracorporeal membrane oxygenation (ECMO) is commonly used for refractory cardiac or respiratory failure. There are reported cases of successful use of ECMO in patients with septic shock; however, there is a lack of evidence to prove its overall efficacy. Thus, we conducted this study to analyze the relationship between sepsis and ECMO in our own patients. METHODS: 305 patients who were placed on ECMO between 2010 and 2020 were identified within an IRB-approved database. Their clinical outcomes were analyzed with a specific focus on patients who were septic before and after ECMO, defined as a positive blood culture. Group S was composed of patients who were septic before or during ECMO. Group N was all patients who were non-septic before and during ECMO. The primary outcomes compared between groups were ECMO survival and 30-day post-ECMO survival. RESULTS: Among the 305 patients on ECMO, 58 (19%) were in Group S and 247 (81%) were in Group N. ECMO survival rates were 45% in group S and 62% in Group N (p¼0.017). The 30-day survival rates were 36% and 47%, respectively (p¼0.12) CONCLUSIONS: Of our 305 patients, patients who were septic upon ECMO placement or those who developed sepsis during ECMO had worse ECMO survival rates than non-septic patients. CLINICAL IMPLICATIONS: Ultimately, patients who are septic or have a high probability of becoming septic may not be indicated for ECMO placement, and cautious administration of ECMO to these patients may be necessary.

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“…The explosion of new knowledge of the pathophysiology of sepsis over the past 40 years has resulted in only modest improvements in treatment. 1 , 2 , 3 , 4 , 5 , 6 , 7 One impactful improvement was the initiation by Rivers et al. 8 of early intravenous fluid therapy to address absolute hypovolemia due to reduced intravascular volume that occurs in sepsis.…”