title: Outcome of Adult Respiratory Failure Patients Receiving Prolonged (≥14 Days) ECMO.
abstract: OBJECTIVE
  To examine the outcomes of prolonged (≥14 days) extracorporeal membrane oxygenation (P-ECMO) for adult severe respiratory failure and to assess characteristics associated with survival.
  
  
  BACKGROUND
  The use of ECMO for treatment of severe respiratory adult patients is associated with overall survival rates of 50% to 70% with median ECMO duration of 10 days. No prior multi-institutional studies have examined outcomes of P-ECMO for severe respiratory failure.
  
  
  METHODS
  Data on all adult (≥18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 were extracted from the Extracorporeal Life Support Organization international multi-institutional registry. We examined outcomes over 23 years and compared the 2 more recent time periods of 1989 to 2006 versus 2007 to 2013.
  
  
  RESULTS
  Up to 974 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range: 14-208 days). Venovenous ECMO support was most common (venovenous: 79.5%, venoarterial: 9.9%). Reason for ECMO discontinuation included native lung recovery (54%), organ failure (23.7%), family request (6.7%), hemorrhage (2.7%), and diagnosis incompatible with life (5.6%). Forty patients (4.1%) underwent lung transplant with 50% postoperative in-hospital mortality. Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported since 2008. Survival to hospital discharge was 45.4% (443/974) and did not vary with ECMO duration. Multivariate logistic regression analysis confirmed that P-ECMO patients 2007 to 2013 had a lower risk of death [odds ratio (OR): 0.650; 95% confidence interval (CI), 0.454-0.929; P = 0.010] compared with 1989 to 2006. Factors independently associated with survival were younger age (OR: 0.983; 95% CI, 0.974-0.993; P < 0.001) and lower PaCO2 (OR, 0.991; 95% CI, 0.986-0.996; P < 0.001).
  
  
  CONCLUSIONS
  Prolonged ECMO use for adult respiratory failure was associated with a lower (45.4%) hospital survival rate, compared with prior reported survival rates of short duration ECMO. Prolonged ECMO survival significantly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the 1989 to 2013 study cohort. Although P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified.
authors.affiliation: *Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI †Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI ‡Department of Anesthesiology, University of Michigan, Ann Arbor, MI §Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI ¶Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Joseph
authors.initials: J
authors.lastname: Posluszny
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Haft
authors.forename: William R
authors.initials: WR
authors.lastname: Lynch
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.forename: Krishnan
authors.initials: K
authors.lastname: Raghavendran
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012131:Respiratory Insufficiency / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome