4 years ago

Retrieval of severe acute respiratory failure patients on ECMO: Any impact on their outcomes?

Mobile ECMO retrieval teams (MERT) assure ECMO implantation and under-ECMO retrieval of most severe acute respiratory failure (ARF) patients to experienced ECMO centers. Although described as feasible, mobile ECMO has only been poorly evaluated in comparison with on-site implantation. This study was undertaken to compare the indications, characteristics and outcomes of MERT-implanted VV-ECMO patients vs those implanted on-site in our ICU. Methods Retrospective single-center study. Results Among 157 VV-ECMO implantations from 2008 to 2012, the MERT hooked-up 118 (75%) patients with refractory ARF, as reflected by their median PaO2/FiO2 of 58 (IQR 50–73). ARF was accompanied by severe multiorgan failure, with median SAPS-II score of 71 (61–81), median SOFA score of 14 (10–16), and with 82% of the patients receiving inotropes. All patients were transported by ground ambulance: median distance 15 (6–25) km and median transport time 35 (25–35) minutes, during which no major ECMO-system–related event occurred. For the MERT- and on-site–implanted groups, respectively, ICU mortality was comparable (46.6% vs 53.8% respectively, p = 0.5), as were ECMO-related complication rates (53.4% of MERT vs 53.8% of on-site–implanted groups, p = 1.0). According to multivariable analysis, MERT ECMO implantation was not associated with ICU mortality (odds ratio, 1.1 [95% CI, 0.4–2.7]; p = 0.85). Conclusions ICU mortality and ECMO-related complications of patients with VV MERT-implanted -ECMO and transferred to our ECMO-referral center were comparable to those implanted on-site by the same team, thereby supporting this strategy to manage severe ARF patients.

Publisher URL: www.sciencedirect.com/science

DOI: S0022522317324315

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