Improvement in the survival rates of extracorporeal membrane oxygenation-supported respiratory failure patients: a multicenter retrospective study in Korean patients
Moon Seong Baek,
Sang-Min Lee,
Chi Ryang Chung,
Woo Hyun Cho,
Young-Jae Cho,
Sunghoon Park,
So-My Koo,
Jae-Seung Jung,
Seung Yong Park,
Youjin Chang,
Byung Ju Kang,
Jung-Hyun Kim,
Jin Young Oh,
So Hee Park,
Jung-Wan Yoo,
Yun Su Sim,
Sang-Bum Hong
Affiliations
Moon Seong Baek
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine
Sang-Min Lee
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine
Chi Ryang Chung
Department of Critical Care Medicine, Samsung Medical Center
Woo Hyun Cho
Department of Internal Medicine, Pusan National University Yangsan Hospital
Young-Jae Cho
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital
Sunghoon Park
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital
So-My Koo
Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital
Jae-Seung Jung
Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University College of Medicine
Seung Yong Park
Department of Internal Medicine, Chonbuk National University Hospital
Youjin Chang
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital
Byung Ju Kang
Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital
Jung-Hyun Kim
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bundang CHA Hospital
Jin Young Oh
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University, Ilsan Hospital
So Hee Park
Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital
Jung-Wan Yoo
Department of Internal Medicine, College of Medicine, Gyeongsang National University Hospital
Yun Su Sim
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Kangnam Sacred Heart Hospital
Sang-Bum Hong
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine
Abstract Background Although the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea. Methods This was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea. The records of all patients who required ECMO for acute respiratory failure between 2012 and 2015 were retrospectively reviewed, and the utilization of ECMO was analyzed over time. Results During the study period, 5552 patients received ECMO in Korea as a whole, and a total of 2472 patients received ECMO at the participating 16 hospitals. We analyzed 487 (19.7%) patients who received ECMO for respiratory failure. The number of ECMO procedures provided for respiratory failure increased from 104 to 153 during the study period. The in-hospital survival rate increased from 30.8% to 35.9%. The use of prone positioning increased from 6.8% to 49.0% (p < 0.001), and the use of neuromuscular blockers also increased from 28.2% to 58.2% (p < 0.001). Multiple regression analysis showed that old age (OR 1.038 (95% CI 1.022, 1.054)), use of corticosteroid (OR 2.251 (95% CI 1.153, 4.397)), continuous renal replacement therapy (OR 2.196 (95% CI 1.135, 4.247)), driving pressure (OR 1.072 (95% CI 1.031, 1.114)), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality. Conclusions Utilization of ECMO and survival rates of patients who received ECMO for respiratory failure increased over time in Korea. The use of pre-ECMO prone positioning and neuromuscular blockers also increased during the same period.
