Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections.
To identify novel factors associated with the survival of septic adults receiving extracorporeal membrane oxygenation (ECMO) to improve patient selection and outcomes.



Cases were identified from our ECMO registry from 2001 to 2011 if they were ≥16 years and received ECMO for life-threatening sepsis.



A total of 151 adults with a median (25th-75th percentile) age of 51 (37-63) years were analyzed. Pneumonia (50%), myocarditis (20%), and primary bloodstream infections (15%) were the main types of infection, caused by predominantly nonfermentative Gram-negative bacteria (NFGNB) (26%), Enterobacteriaceae (24%), and Gram-positive cocci (21%). The in-hospital mortality of patients with NFGNB, enteric, and Gram-positive bacterial pneumonias were 100%, 68%, and 14%, respectively. Using the Cox-proportional hazards model, we found that age >75 years (hazard ratio [HR], 1.98, 95% confidence interval [95% CI], 1.30-3.02), pre-ECMO dialysis (HR, 3.20, 95% CI, 1.34-7.63), longer door-to-ECMO intervals (HR, 1.01, 95% CI, 1.00-1.02), venoarterial mode (HR, 2.58, 95% CI, 1.55-4.21), and fungal (HR, 2.83, 95% CI, 1.36-5.88) and NFGNB sepsis (HR, 2.48, 95% CI, 1.44-4.27) were associated with mortality. Gram-positive sepsis (HR, 0.20, 95% CI, 0.08-0.57), myocarditis (HR, 0.12, 95% CI, 0.06-0.27), pneumonia (HR, 0.54, 95% CI, 0.30-0.90), and effective empirical antimicrobial therapy were predictive of survival (HR, 0.57, 95% CI, 0.37-0.89); all P < .05. Excluding the 67 heavily premorbid patients, we found that 54% survived ECMO and 42% survived to discharge, with significantly more survivors with door-to-ECMO times of ≤96 hours than >96 hours (59% vs 15%, P < .0001).



Better outcomes were associated with door-to ECMO times of 96 hours or less, for Gram-positive rather than Gram-negative sepsis, and for pneumonia rather than primary bloodstream infections.
Department of Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; Department of Medicine, National Taiwan University Hospital, Main Branch and College of Medicine, Taipei, Taiwan.
Aristine
A
Cheng
Department of Medicine, National Taiwan University Hospital, Main Branch and College of Medicine, Taipei, Taiwan.
Hsin-Yun
HY
Sun
Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Mao-Song
MS
Tsai
Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Wen-Je
WJ
Ko
International Harvard Statistical Consulting Company, Taipei, Taiwan.
Pi-Ru
PR
Tsai
International Harvard Statistical Consulting Company, Taipei, Taiwan.
Fu-Chang
FC
Hu
Department of Medicine, National Taiwan University Hospital, Main Branch and College of Medicine, Taipei, Taiwan.
Yee-Chun
YC
Chen
Department of Medicine, National Taiwan University Hospital, Main Branch and College of Medicine, Taipei, Taiwan. Electronic address: changsc@ntu.edu.tw.
Shan-Chwen
SC
Chang
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D061665:Time-to-Treatment
ARDS; community-acquired pneumonia; early rescue; extracorporeal life support; infections; sepsis; shock