Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Abstract

AimThis multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.MethodsThe data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno‐venous ECMO support. The main outcome was in‐hospital all‐cause mortality.ResultsOf 3195 patients with severe sepsis, 570 had severe respiratory failure. Forty patients in the ECMO group were matched with 150 patients in the control group. A survival time analysis revealed no difference in the in‐hospital survival (hazard ratio, 0.854; 95% confidence interval, 0.531–1.373; P = 0.515). Two‐hundred and eighty‐five patients had severe respiratory failure induced by lung infection. Twenty‐five ECMO group patients were matched with 89 patients in the control group. In the ECMO group, the survival time was longer than in the control group (hazard ratio, 0.498; 95% confidence interval, 0.279–0.889; P = 0.018). The number of renal replacement therapy‐ and vasopressor‐free days improved. The ECMO group received more red blood cells transfused than the control group, but there was no significant difference in the rate of severe bleeding complications between the groups.ConclusionsThere was no difference in the in‐hospital survival between the ECMO group and control group among overall septic patients with severe respiratory failure. However, in sepsis patients with severe respiratory failure induced by lung infection, ECMO support may improve their survival time.

Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis

“…VA ECMO has been found to be a risk factor for mortality when compared to venovenous ECMO (VV ECMO) in patients with sepsis [19][20][21]. This might be due to the differing indications for ECMO in sepsis (concomitant hypoxemia and right ventricular dysfunction in VV ECMO vs. cardiomyopathy and vasoplegia in VA ECMO), potentially reflecting less severe disease for patients supported with VV ECMO.…”

A propósito de la contingencia COVID-19. ECMO en el adulto: Oxigenación por membrana extracorpórea. A quién, cómo y cuándo

“…Aunque se necesitan más datos y estudios al respecto, el ECLS parece tener un lugar en: 1. Disfunción pulmonar severa y shock séptico, con sobrevida alrededor de 70% (indicación es ECMO VV) 38 . 1.…”

Use of ECMO in Sepsis and Septic Shock

“…The available literature on ECMO use in adult septic shock patients consists mainly of case reports or (usually single-centered) retrospective case series. In a recent multicenter study [10], the data from 42 Japanese intensive care units were retrospectively collected and propensity score analysis was performed. Out of 3195 patients included in the JSEPTIC DIC study [11], 570 patients suffered from severe respiratory failure and in 285 of them respiratory failure was induced by lung infection.…”

“…In another case series [16], 14 patients received ECMO support as salvage therapy for refractory septic shock, 24 h (3-108) after shock onset. Mean simplified acute physiology score (SAPS) III was 84 (75-106) SOFA score was 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Twelve patients (86%) could be weaned off and 10 patients (71%) were discharged home and were alive after a median follow-up of 13 months (3-43) with normalized ejection fraction and a good quality of life.…”