title: Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults: A Nationwide Cohort Study.
abstract: Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for patients with severe acute cardiopulmonary failure. The objective of this study was to examine the survival outcomes for patients who received ECMO.
  
  
  
  Adult patients who received ECMO from September 1, 2002, to December 31, 2012, were identified from the Taiwan National Health Insurance Database associated with coronary artery bypass graft surgery, myocardial infarction/cardiogenic shock, injury, and infection/septic shock. A Cox regression model was used to determine hazard ratios and to compare 30-day and 1-year survival rates with the myocardial infarction/cardiogenic shock group used as the reference. The mean±SD age of the 4227-patient cohort was 57±17 years, and 72% were male. The overall mortalities were 59.8% and 76.5% at 1 month and 1 year. Survival statistics deteriorated sharply when ECMO was required for >3 days. Acute (30-day) survival was more favorable in the infection/septic shock (n=1076; hazard ratio, 0.61; 95% confidence interval, 0.55-0.67), coronary artery bypass graft surgery (n=1077; hazard ratio, 0.68; 95% confidence interval, 0.61-0.75), and injury (n=369, hazard ratio, 0.82; 95% confidence interval, 0.70-0.95) groups. The extended survival rapidly approached an asymptote near 20% for the infection/septic shock, myocardial infarction/cardiogenic shock (n=1705), and coronary artery bypass graft surgery groups. The pattern of survival for the injury group was somewhat better, exceeding 30% at year-end.
  
  
  
  Regardless of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses. Those in the trauma group had somewhat better outcomes. Determining the efficacy and cost-effectiveness of ECMO should be a critical future goal.
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: Chia-Hsuin
authors.initials: CH
authors.lastname: Chang
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: Hsi-Chieh
authors.initials: HC
authors.lastname: Chen
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: James L
authors.initials: JL
authors.lastname: Caffrey
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: Jiun
authors.initials: J
authors.lastname: Hsu
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.). jouweilin@yahoo.com.
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
authors.affiliation: From the Institute of Epidemiology and Preventive Medicine, College of Public Health (C.-H.C., H.C.-C., M.-S.L.), Department of Medicine, College of Medicine (C.-H.C., J.-W.L.), Department of Internal Medicine, (C.-H.C.); Institute of Health Policy and Management, College of Public Health (H.C.-C.), and Department of Surgery (Y.-S.C.), National Taiwan University, Taipei, Taiwan; Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, Ft. Worth (J.L.C.); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J.H., J.-W.L.).
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
mesh_terms: D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
keywords: cohort studies; extracorporeal membrane oxygenation; shock; survival; wounds and injuries