Six-month Outcome of Immunocompromised Severe ARDS Patients Rescued by ECMO. An International Multicenter Retrospective Study

TitreSix-month Outcome of Immunocompromised Severe ARDS Patients Rescued by ECMO. An International Multicenter Retrospective Study
Type de publicationArticle de revue
AuteurSchmidt, Matthieu, Schellongowski, Peter, Patroniti, Nicolò, Taccone, Fabio Silvio, Reis Miranda, Dinis, Reuter, Jean, Prodanovic, Helène, Pierrot, Marc , Dorget, Amandine, Park, Sunghoon, Balik, Martin, Demoule, Alexandre, Crippa, Ilaria Alice, Mercat, Alain
1, 2
, Wohlfarth, Philipp, Sonneville, Romain, Combes, Alain
OrganismeInternational ECMO Network (ECMONet), REVA Research Networ, IDEA Study Group
EditeurATS Journal
TypeArticle scientifique dans une revue à comité de lecture
Date15 Mai 2018
Titre de la revueAmerican Journal of Respiratory and Critical Care Medicine
Mots-clésAcute respiratory distress syndrome, Extracorporeal Membrane Oxygenation, hematological malignancies, immunodeficiency, outcome
Résumé en anglais

OBJECTIVES: To report outcomes of immunocompromised patients treated with extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) and to identify their pre-ECMO predictors of 6-month mortality and main ECMO-related complications.

METHODS: Retrospective multicenter study in 10 international intensive care units (ICUs) with high ECMO-case volumes. Immunocompromised patients, defined as having hematological malignancies, active solid tumor, solid-organ transplant, acquired immunodeficiency syndrome, or long-term or high-dose corticosteroid or immunosuppressant use, and severe ECMO-treated ARDS from 2008 to 2015 were included Measurements and Main Results: We collected demographics, clinical, ECMO-related complications, ICU- and 6-month-outcome data for 203 patients (median APACHE II 28 [25th ;75th percentile, 20;33]; age 51 [38;59] years, PaO2/FiO2 60 [50;82] mmHg before ECMO) who fulfilled our inclusion criteria. Six-month survival was only 30%, with a respective median ECMO duration and ICU stay of 8 [5;14] and 25 [16;50] days. Patients with hematological malignancies had significantly poorer outcomes than others (log-rank P=0.02). Multivariate analyses retained <30 days between immunodeficiency diagnosis and ECMO cannulation as being associated with lower 6-month mortality (odds ratio 0.32 (95% confidence interval 0.16-0.66); P=0.002), and lower platelet count, higher PCO2, age and driving pressure as independent pre-ECMO predictors of 6-month mortality.

CONCLUSION: Recently diagnosed immunodeficiency is associated with a much better prognosis in ECMO-treated severe ARDS. However, low 6-month survival of our large cohort of immunocompromised patients supports restricting ECMO to patients with realistic oncological/therapeutic prognoses, acceptable functional status and few pre-ECMO mortality-risk factors.

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Titre abrégéAm. J. Respir. Crit. Care Med.
Identifiant (ID) PubMed29298095