Formal Project Prize Session
The Characteristics and Risk-adjusted Outcome of Patients Receiving Extracorporeal Membrane Oxygenation in a Tertiary Intensive Care Unit in Hong Kong
Wai-Tsan NG, KM CHAN
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
Objective: Outcome of patients receiving extracorporeal membrane oxygenation (ECMO) therapies risk-adjusted by ECMO-specific scores has rarely been reported. Our aim is to review the characteristics and outcome of these patients, including the use of standardized mortality ratio (SMR) with ECMO-specific scores, thereby reviewing and enhancing our local practice.
Design, Setting, Participants, Main outcome measures: This is a single-center retrospective audit reviewing 62 patients who received VV-ECMO and VA-ECMO between 2009 and 2017 in a tertiary Intensive Care Unit. Demographic, clinical, laboratory and imaging data were analyzed. Primary outcomes include crude mortality and SMR (expressed as a ratio of the observed hospital mortality divided by the predicted hospital mortality derived from RESP and SAVE-scores). Secondary outcomes include the complications, ICU and hospital length of stay, and ECMO duration.
Results: 20 and 42 patients received VV-ECMO (20 runs) and VA-ECMO (43 runs) respectively. Hospital and six-month mortality were 50% in both groups. For VV-ECMO, the mean RESP-score± standard deviation(SD) was 0.6± 4.86 with RESP-SMR of 1.16 (95% Confidence Interval [95% CI]=0.44-1.88). For VA-ECMO, the mean SAVE-score± SD was -7.8± 5.82, with SAVE-SMR of 0.69 (95% CI=0.39-0.98). The most common complications were ECMO-associated nosocomial infection (45% VV-ECMO,52% VA-ECMO) and major bleeding (40% VV-ECMO,36% VA-ECMO).
Conclusions: Our results show that the observed mortality is better than predicted for VA-ECMO and similar to predicted for VV-ECMO. ECMO-associated nosocomial infection and bleeding were the most common complications in VV-ECMO and VA-ECMO. This study provides important information for benchmarking and further improvement.