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Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study.
J Crit Care. 2016 06; 33:169-73.JC

Abstract

PURPOSE

The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Pao2/fraction of inspired oxygen <100) who received early veno-venous extracorporeal membrane oxygenation (ECMO) as an adjunct to mechanical ventilation, to those in patients who received conventional mechanical ventilation alone.

MATERIALS AND METHODS

This is a multicenter, retrospective unmatched and matched cohort study of patients admitted between April 2006 and December 2013. Generalized logistic mixed-effects models and Cox proportional hazards models were used to determine the association between treatment with ECMO that was started within 3 days of intensive care unit (ICU) admission and ICU and hospital mortality and length of stay, respectively.

RESULTS

A total of 2440 patients who had severe hypoxemic respiratory failure due to various etiologies were included, 46 who received early veno-venous ECMO and 2394 unmatched and 398 matched controls who received conventional ventilation alone. Compared to matched controls, ECMO was associated with a lower odds of ICU (odds ratio [95% confidence interval], 0.30 [0.13-0.67]) and inhospital death (odds ratio 0.30 [0.14-0.67]). In addition, ECMO was associated with longer times to discharge from ICU and hospital (hazard ratio, 0.42 [0.37-0.47] and 0.53 [0.38-0.73], respectively).

CONCLUSIONS

In this observational study, use of early ECMO compared to conventional mechanical ventilation alone in patients who had severe hypoxemic respiratory failure was associated with a lower risk of mortality and a longer length of stay.

Authors+Show Affiliations

Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada. Electronic address: hdkanji@gmail.com.Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Heart Centre, St Paul's Hospital, Vancouver, BC, Canada.Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26971033

Citation

Kanji, Hussein D., et al. "Early Veno-venous Extracorporeal Membrane Oxygenation Is Associated With Lower Mortality in Patients Who Have Severe Hypoxemic Respiratory Failure: a Retrospective Multicenter Cohort Study." Journal of Critical Care, vol. 33, 2016, pp. 169-73.
Kanji HD, McCallum J, Norena M, et al. Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study. J Crit Care. 2016;33:169-73.
Kanji, H. D., McCallum, J., Norena, M., Wong, H., Griesdale, D. E., Reynolds, S., Isac, G., Sirounis, D., Gunning, D., Finlayson, G., & Dodek, P. (2016). Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study. Journal of Critical Care, 33, 169-73. https://doi.org/10.1016/j.jcrc.2016.01.010
Kanji HD, et al. Early Veno-venous Extracorporeal Membrane Oxygenation Is Associated With Lower Mortality in Patients Who Have Severe Hypoxemic Respiratory Failure: a Retrospective Multicenter Cohort Study. J Crit Care. 2016;33:169-73. PubMed PMID: 26971033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study. AU - Kanji,Hussein D, AU - McCallum,Jessica, AU - Norena,Monica, AU - Wong,Hubert, AU - Griesdale,Donald E, AU - Reynolds,Steven, AU - Isac,George, AU - Sirounis,Demetrios, AU - Gunning,Derek, AU - Finlayson,Gordon, AU - Dodek,Peter, Y1 - 2016/01/13/ PY - 2015/09/28/received PY - 2015/12/02/revised PY - 2016/01/07/accepted PY - 2016/3/14/entrez PY - 2016/3/14/pubmed PY - 2017/9/14/medline KW - Acute respiratory distress syndrome KW - Critical care KW - Extracorporeal membrane oxygenation KW - Respiratory failure SP - 169 EP - 73 JF - Journal of critical care JO - J Crit Care VL - 33 N2 - PURPOSE: The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Pao2/fraction of inspired oxygen <100) who received early veno-venous extracorporeal membrane oxygenation (ECMO) as an adjunct to mechanical ventilation, to those in patients who received conventional mechanical ventilation alone. MATERIALS AND METHODS: This is a multicenter, retrospective unmatched and matched cohort study of patients admitted between April 2006 and December 2013. Generalized logistic mixed-effects models and Cox proportional hazards models were used to determine the association between treatment with ECMO that was started within 3 days of intensive care unit (ICU) admission and ICU and hospital mortality and length of stay, respectively. RESULTS: A total of 2440 patients who had severe hypoxemic respiratory failure due to various etiologies were included, 46 who received early veno-venous ECMO and 2394 unmatched and 398 matched controls who received conventional ventilation alone. Compared to matched controls, ECMO was associated with a lower odds of ICU (odds ratio [95% confidence interval], 0.30 [0.13-0.67]) and inhospital death (odds ratio 0.30 [0.14-0.67]). In addition, ECMO was associated with longer times to discharge from ICU and hospital (hazard ratio, 0.42 [0.37-0.47] and 0.53 [0.38-0.73], respectively). CONCLUSIONS: In this observational study, use of early ECMO compared to conventional mechanical ventilation alone in patients who had severe hypoxemic respiratory failure was associated with a lower risk of mortality and a longer length of stay. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/26971033/Early_veno_venous_extracorporeal_membrane_oxygenation_is_associated_with_lower_mortality_in_patients_who_have_severe_hypoxemic_respiratory_failure:_A_retrospective_multicenter_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(16)00011-3 DB - PRIME DP - Unbound Medicine ER -