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Crit Care. 2016 Apr 5;20:80. doi: 10.1186/s13054-016-1261-1.

In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan.

Author information

1
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
2
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
3
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. yasunagah-tky@umin.ac.jp.

Abstract

BACKGROUND:

The mortality rate of severely ill patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unknown because of differences in patient background, clinical settings, and sample sizes between studies. We determined the in-hospital mortality of VA-ECMO patients and the proportion weaned from VA-ECMO using a national inpatient database in Japan.

METHODS:

Patients aged ≥ 19 years who received VA-ECMO during hospitalization for cardiogenic shock, pulmonary embolism, hypothermia, poisoning, or trauma between 1 July 2010 and 31 March 2013 were identified, using The Japanese Diagnosis Procedure Combination national inpatient database.

RESULTS:

The primary outcome was in-hospital mortality and the secondary outcome was the proportion weaned from VA-ECMO. A total of 5263 patients received VA-ECMO during the study period. The majority of patients had cardiogenic shock (n = 4,658). The number of patients weaned from VA-ECMO was 3389 (64.4%) and in-hospital mortality after weaning from VA-ECMO was 1994 (37.9%). In-hospital mortality without cardiac arrest in the cardiogenic shock group was significantly lower than that in patients with cardiac arrest (70.5% vs. 77.1%, p <0.001). In the multivariable logistic regression including multiple imputation, higher age and greater or smaller body mass index were significantly associated with in-hospital mortality, whereas hospital volume was not associated with such mortality.

CONCLUSIONS:

The present nationwide study showed high mortality rates in patients who received VA-ECMO, and in particular in patients with cardiogenic shock and in patients with cardiac arrest. Weaning from VA-ECMO did not necessarily result in survival. Further studies are warranted to clarify risk-adjusted mortality of VA-ECMO using more detailed data on patient background.

KEYWORDS:

Age factors; Cardiac arrest; Cardiogenic shock; Extracorporeal membrane oxygenation; Mortality

PMID:
27044572
PMCID:
PMC4820970
DOI:
10.1186/s13054-016-1261-1
[Indexed for MEDLINE]
Free PMC Article

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