Age and associated outcomes among patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory failure: analysis of the Extracorporeal Life Support Organization registry

Shannon M Fernando; Daniel Brodie; Ryan P Barbaro; Cara Agerstrand; Jenelle Badulak; Errol L Bush; Thomas Mueller; Laveena Munshi; Eddy Fan; Graeme MacLaren; Daniel I McIsaac

doi:10.1007/s00134-024-07343-5

Age and associated outcomes among patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory failure: analysis of the Extracorporeal Life Support Organization registry

Intensive Care Med. 2024 Mar;50(3):395-405. doi: 10.1007/s00134-024-07343-5. Epub 2024 Feb 20.

Authors

Shannon M Fernando^#^{1

2}, Daniel Brodie^#³, Ryan P Barbaro^{4

5}, Cara Agerstrand^{6

7}, Jenelle Badulak^{8

9}, Errol L Bush¹⁰, Thomas Mueller¹¹, Laveena Munshi^{12

13}, Eddy Fan^{12

13}, Graeme MacLaren^#^{14

15}, Daniel I McIsaac^#^{16

17

18}

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. sfernando@qmed.ca.
² Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada. sfernando@qmed.ca.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
⁶ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
⁷ Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
⁸ Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
⁹ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
¹⁰ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹¹ Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany.
¹² Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁵ Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore.
¹⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁷ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

^# Contributed equally.

PMID: 38376515
DOI: 10.1007/s00134-024-07343-5

Abstract

Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support patients with refractory acute respiratory failure, though guidance on patient selection is lacking. While age is commonly utilized as a factor in establishing the potential VV-ECMO candidacy of these patients, little is known regarding its association with outcome. We studied the association between increasing patient age and outcomes among patients with acute respiratory failure receiving VV-ECMO.

Methods: In this registry-based cohort study, we used individual patient data from 144 centres. We included adult patients (≥ 18 years of age) receiving VV-ECMO from 2017 to 2022. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of VV-ECMO. We conducted Bayesian analyses to estimate the association between chronological age and outcomes.

Results: We included 27,811 patients receiving VV-ECMO. Of these, 11,533 (41.5%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18-29, the age brackets of 30-39 (odds ratio [OR] 1.17, 95% credible interval [CrI] 1.06-1.31), 40-49 (OR 1.65, 95% CrI 1.49-1.82), 50-59 (OR 2.39, 95% CrI 2.16-2.61), 60-69 (OR 3.29, 95% CrI 2.97-3.67), 70-79 (OR 4.57, 95% CrI 3.90-5.37), and ≥ 80 (OR 8.08, 95% CrI 4.85-13.74) were independently associated with increasing hospital mortality. Similar results were found between increasing age and post-ECMO complications.

Conclusions: Among patients receiving VV-ECMO for acute respiratory failure, increasing age is significantly associated with poorer outcomes, and this association emerges as early as 30 years of age.

Keywords: Acute respiratory distress syndrome; COVID-19; Extracorporeal life support; Extracorporeal membrane oxygenation; Respiratory failure.

MeSH terms

Adolescent
Adult
Bayes Theorem
Cohort Studies
Extracorporeal Membrane Oxygenation* / methods
Humans
Registries
Respiratory Distress Syndrome*
Respiratory Insufficiency*
Retrospective Studies
Young Adult