title: Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  Extracorporeal Life Support Organization Registry database.
  
  
  METHODS
  We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality.
  
  
  METHODS
  None.
  
  
  RESULTS
  One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal pneumonia, and advancing age. Type and duration of extracorporeal membrane oxygenation, neurologic complications, and presence of more than three complications on extracorporeal membrane oxygenation were also associated with higher mortality.
  
  
  CONCLUSIONS
  The majority (66%) of adults with community-acquired pneumonia supported on extracorporeal membrane oxygenation survived. Certain potentially modifiable risk factors were associated with increased mortality.
authors.affiliation: 1Cardiothoracic Intensive Care Unit, National University Heart Center, Singapore. 2Swee Saw Hock School of Public Health, National University of Singapore, Singapore. 3Extracorporeal Life Support Organisation, Ann Arbor, MI.
authors.forename: Kollengode
authors.initials: K
authors.lastname: Ramanathan
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
mesh_terms: D000293:Adolescent; D000328:Adult; D017714:Community-Acquired Infections; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D012042:Registries / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult