Retrieval of severe acute respiratory failure patients on extracorporeal membrane oxygenation: Any impact on their outcomes?

Nicolas Bréchot; Ciro Mastroianni; Matthieu Schmidt; Francesca Santi; Guillaume Lebreton; Anne-Marie Hoareau; Charles-Edouard Luyt; Juliette Chommeloux; Marina Rigolet; Said Lebbah; Guillaume Hekimian; Pascal Leprince; Alain Combes

doi:10.1016/j.jtcvs.2017.10.084

Retrieval of severe acute respiratory failure patients on extracorporeal membrane oxygenation: Any impact on their outcomes?

J Thorac Cardiovasc Surg. 2018 Apr;155(4):1621-1629.e2. doi: 10.1016/j.jtcvs.2017.10.084. Epub 2017 Nov 8.

Affiliations

¹ Medical-Surgical ICU, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1050, Centre for Interdisciplinary Research in Biology (CIRB), College de France, CNRS, INSERM, PSL Research University, Paris, France. Electronic address: nicolas.brechot@aphp.fr.
² Cardiac Surgery Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, UPMC Univ Paris 06, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.
³ Medical-Surgical ICU, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, UPMC Univ Paris 06, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.
⁴ Cardiac Surgery Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Medical-Surgical ICU, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁶ Clinical Research Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.

PMID: 29246547
DOI: 10.1016/j.jtcvs.2017.10.084

Abstract

Objective: Mobile extracorporeal membrane oxygenation (ECMO) retrieval teams (MERTs) assure ECMO implantation and under-ECMO retrieval of patients with most severe acute respiratory failure (ARF) 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 patients with venovenous (VV)-ECMO versus those implanted on site in our intensive care unit (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 partial pressure of O₂ in arterial blood/fraction of inspired oxygen of 58 (interquartile range, 50-73). ARF was accompanied by severe multiorgan failure, with a median Simplified Acute Physiology Score-II of 71 (61-81), median Sequential Organ Failure Assessment score of 14 (10-16), and with 82% of the patients receiving inotropes. All patients were transported by ground ambulance: median distance was 15 (6-25) km, and median transport time was 35 (25-35) minutes, during which no major ECMO system-related event occurred. For the MERT- and on-site-implanted groups, ICU mortality was comparable (46.6% vs 53.8%, respectively, P = .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% confidence interval, 0.4-2.7; P = .85).

Conclusions: ICU mortality and ECMO-related complications of patients with MERT-implanted VV-ECMO who were transferred to our ECMO referral center were comparable with those implanted on site by the same team, thereby supporting this strategy to manage patients with severe ARF.

Keywords: acute respiratory distress syndrome; acute respiratory failure; extracorporeal membrane oxygenation; mobile; retrieval.

Publication types

Comparative Study
Video-Audio Media

MeSH terms

Acute Disease
Adult
Ambulances*
Databases, Factual
Extracorporeal Membrane Oxygenation / adverse effects
Extracorporeal Membrane Oxygenation / instrumentation
Extracorporeal Membrane Oxygenation / methods*
Extracorporeal Membrane Oxygenation / mortality
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Patient Transfer*
Respiratory Insufficiency / diagnosis
Respiratory Insufficiency / mortality
Respiratory Insufficiency / physiopathology
Respiratory Insufficiency / therapy*
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome