Survival Analysis Following Extracorporeal Membrane Oxygenation in Critically Ill Adults: A Nationwide Cohort Study
Background—Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for patients with severe acute cardiopulmonary failure. The objective of this study was to examine the survival outcomes for patients who received ECMO.
Methods and Results—Adult patients who received ECMO from September 1, 2002 to December 31, 2012 were identified from Taiwan's National Health Insurance Database associated with 1) coronary artery bypass surgery (CABG), 2) myocardial infarction/cardiogenic shock (MI/CS), 3) injury, and 4) infection/septic shock (Infection). A Cox-regression model was used to determine hazard ratios (HR) and compare 30-day and one-year survival rates using the MI/CS group as the reference. The mean age and standard deviation of the 4,227 patient cohort was 57±17 years and 72% were male. The overall mortalities were 59.8% and 76.5% at one month and one year. Survival statistics deteriorated sharply when ECMO was required for more than 3 days. Acute (30-day) survival was more favorable in the Infection (n = 1,076, HR: 0.61, 95% CI: 0.55-0.67), CABG (n = 1,077, HR: 0.68 [0.61-0.75]), and Injury (n = 369, HR: 0.82 [0.70-0.95]) groups. The extended survival rapidly approached an asymptote near 20% for the Infection, MI/CS (n = 1,705), and CABG groups. The pattern of survival for the injury group was somewhat better, exceeding 30% at yearend.
Conclusions—Regardless of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses. Those in the trauma group had somewhat better outcomes. Determining the efficacy and cost-effectiveness of ECMO should be a critical future goal.
- Received August 22, 2015.
- Revision received April 6, 2016.
- Accepted April 19, 2016.