SESSION TITLE: Novel Assessment and Treatments for Respiratory Failure
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM
PURPOSE: Approximately 7% of patients with status asthmaticus (SA) and 11% of patients with chronic obstructive pulmonary disease exacerbations (AECOPD) die each year despite maximal conventional therapy and mechanical ventilator (MV) support. The use of extracorporeal membrane oxygenation (ECMO) in patients with obstructive lung diseases is uncommon. Our objective was to review the characteristics and outcomes in patients on ECMO for SA and AECOPD in comparison to other causes of respiratory failure.
METHODS: We conducted a retrospective cohort study using the international Extracorporeal Life Support Organization registry and included all adult (≥18 years of age) cases between January 1988 and December 2014 in our analysis. Primary outcome was survival to hospital discharge. Student’s t-test was used to compare continuous variable and chi-squared statistic was used to compare categorical variables. Multivariable logistic regression was performed to determine the odds of survival on ECMO while adjusting for potential confounding.
RESULTS: 456 adult respiratory failure ECMO cases were reported to the ECLS registry and survival to hospital discharge was 61.6% for these patients. SA and AECOPD was the primary indication in 129 cases, they were younger (mean age 39.2 vs 50.4 years, p<0.0001) with no difference in gender (males 43.4% vs 49.54%, p=0.23) or race (Caucasian 60.47% vs 68.8%, p=0.09) when compared to patients on ECMO for other causes of respiratory failure. They were more acidotic at initiation of ECMO (7.10 vs 7.23, p=0.01) but had lower oxygen requirement (FiO2 0.81 vs 0.92, p<0.001) and shorter duration on ECMO (110.8 vs 184.9 days, p= 0.002). Veno-venous ECMO was used more frequently in patients with SA and AECOPD (82.35% vs 56.92%, p=0.0003). On multivariate analysis, patients with SA and AECOPD had a higher survival to hospital discharge (OR 1.98, CI 1.04 - 3.77,p=0.03) compared to patients on ECMO for other causes of respiratory failure, while adjusting for age, race, gender, oxygen requirement and hours of ECMO.
CONCLUSIONS: In conclusion, our review of the ELSO registry suggests that ECMO may be beneficial in adult patients with life-threatening SA and AECOPD refractory to maximal pharmacological therapy and MV. Further studies are needed to determine if ECMO use can reduce morbidity or mortality in these patients.
CLINICAL IMPLICATIONS: ECMO may be useful in patients with refractory SA or AECOPD on MV for providing adequate gas change and improving survival.
DISCLOSURE: The following authors have nothing to disclose: Tejaswini Kulkarni, Krittika Teerapuncharoen, Nirmal Sharma, Keith Wille, Enrique Diaz-Guzman
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