title: The outcome of patients requiring multiple extracorporeal membrane oxygenation: how many runs of ECMO is reasonable?
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) has been proven effective in life support for patients with refractory cardiopulmonary failure. Deteriorating patients who have removed their first ECMO support and required second or more courses of ECMO support have rarely been discussed.
  
  
  RESULTS
  All the records of the patients who experienced at least 2 courses of ECMO during single admission were retrieved. Survival was defined as survival to discharge. Demographic data and clinical information were compared between survival and nonsurvival groups. There were 86 patients who received at least 2 courses of ECMO in the 20-year database, and 27 (31.3%) were &lt;18 years old. Of them, 87.3% received 2 runs of ECMO, 10.4% 3 runs, and 2.3% 4 runs. Overall survival rate was 30.2%. The survival rate for patients with 2 runs of ECMO was 33.3% (25 out of 75), 11.1% (1 out of 9) for 3 runs, and 0% (0 out of 2) for 4 runs. Multivariate analysis revealed that only ARF with hemodialysis was the independent risk factor.
  
  
  CONCLUSIONS
  The decision to perform repeated ECMO implantation is a complex and difficult process. Despite the arguments debating the consumption of resources and increased complications, there are still nearly 1 out of 3 patients who will survive to discharge. More than 2 courses of ECMO may be carefully considered for further rescue.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei - Taiwan.
authors.forename: Heng-Wen
authors.initials: HW
authors.lastname: Chou
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei - Taiwan.|Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei - Taiwan.
authors.forename: Te-I
authors.initials: TI
authors.lastname: Chang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Nai-Kuan
authors.initials: NK
authors.lastname: Chou
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Nai-Hsin
authors.initials: NH
authors.lastname: Chi
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Shu-Chien
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: I-Hui
authors.initials: IH
authors.lastname: Wu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Lee-Mei
authors.initials: LM
authors.lastname: Ponge
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Ya-Chen
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei - Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult