Abstract 297: The Evolving Role for Extracorporeal Membrane Oxygenator in Overwhelming Septic Shock
Advances in extracorporeal membrane oxygenator (ECMO) has improved survival in patients with respiratory failure or cardiac shock, however, the role in overwhelming sepsis is unclear.
Methods: We retrospectively reviewed of our experience with ECMO as salvage therapy for severe septic shock. Those weaned vs. not weaned from ECMO were compared.
Results: From 01/2009 to 12/2009, 14 patients were supported with peripheral ECMO (5 veno-arterial, 9 veno-veno) for severe shock secondary to Influenza H1N1 (n=8), necrotizing fascilitis (n=2), bacteremia/pneumonia (n=4). Average pre-ECMO SAPS-II predicted mortality was 61+/−26%. Four died on ECMO due to medical futility, 2 weaned patients died from pre-existing comorbidities. Those weaned were younger (30.2+/−9.3 vs 41.9+/−10.1 years, p=0.04), had ECMO initiated earlier after mechanical ventilation (0.9+/1.3 vs 8.5+/5.9 days, p<0.01), and had fewer days of support (9.5+/−4.8 vs 15+/−6.4, p=0.05). Surgical procedures on ECMO were common (3 thoracotomies, 1 laparotomy, 2 multiple tissue debridements, and 4 cannula revisions). 7 required dialysis (3 not wean, 4 weaned, p=NS) — all weaned resolved their renal failure. Pre-ECMO pH, PaO2, and SAPS-II scores were similar for those weaned vs not. Weaned patients were less hypercarbic (51±13 vs 78±33 mmHg, p=0.3) and more acidotic (base excess: -7±7 vs +2.1±9 mMol/l, p=0.03). All patients resolved precipitating infections. Hospital survival was 57%.
Conclusions: ECMO may be an option for patients whose cardiac/respiratory function may inadequately support the metabolic demands until their sepsis is controlled. Younger patients treated earlier by ECMO, with fewer co-morbidities had better outcomes. Prolonged intubation and compensated hypercarbia are poor prognostic indicators.
- © 2010 by American Heart Association, Inc.