Understanding Survival Factors in Critically Ill Patients on Extracorporeal Membrane Oxygenation

Scientists from Korea have identified the factors associated with in-hospital mortality in critically ill patients requiring extracorporeal membrane oxygenation

SEOUL, Nov. 17, 2023 /PRNewswire/ -- Extracorporeal membrane oxygenation (ECMO), a widely used life support modality, is associated with a high in-hospital mortality rate. Now, researchers from Chung-Ang University, Korea have assessed the prevalence of ECMO-associated deaths and identified the related risk factors. These findings aim to enhance the management of patients requiring ECMO.

Extracorporeal membrane oxygenation (ECMO) is a vital life support procedure that provides cardiac and respiratory support to critically ill patients. ECMO use has significantly increased over the last decade, making it a crucial treatment modality in intensive care units (ICUs), especially after the COVID-19 pandemic. However, prolonged ECMO use is associated with an increased risk of mortality. Identifying risk factors for in-hospital mortality and developing standardized nursing practice guidelines for ECMO management may improve survival rates.

Thus, a group of researchers, led by Professor Youn-Jung Son from Chung-Ang University, South Korea, conducted a retrospective cohort study to evaluate the prevalence and risk factors associated with the 30-day in-hospital mortality in critically ill adult Korean patients on ECMO. This paper was made available online on July 12, 2023 and will be published in Volume 79 of the journal Intensive and Critical Care Nursing on 1st December 2023.

"In-hospital mortality due to ECMO support has not been well reported in Korea. Thus, it is crucial to train various stakeholders in Korea (e.g., ICU nurses) to enhance collaboration, particularly to improve the survival rate post-hospital discharge." explains Prof. Son.

The study was conducted in a single tertiary-care university hospital between May 2020 and April 2021. It encompassed 148 patients aged 18 years or above, who received ECMO support for at least 48 hours. Based on their 30-day in-hospital survival status following ECMO initiation, the patients were categorized as survivors or non-survivors. Various pre-ECMO and post-ECMO parameters were collected and compared.

The 30-day in-hospital mortality rate was found to be 49.3%, with heart and multi-organ failures identified as the leading causes of death. Thus, early detection of risk factors for mortality to improve patient outcomes is crucial.

Statistical analyses revealed that ECMO weaning failure, new-onset renal failure, and a lower average mean arterial pressure (MAP) of <65 mmHg post-ECMO were associated with an increased risk of 30-day in-hospital mortality rate. Among these, ECMO weaning failure was the strongest predictor of death in patients requiring ECMO.

This study is the first of its kind in Korea, and underscores the importance of vigilant monitoring of post-ECMO renal function and average MAP to minimize the death rate, especially within the first two weeks of ECMO initiation.

In Korea, ICU nurses are the primary medical staff caring for ECMO patients, yet specific training modules or qualification exams for this role are lacking. This study highlights the role of ICU nurses in reducing ECMO mortality rates and provides significant evidence-based framework for development of nursing practice guidelines.

Elaborating on the study's long-term impacts, Prof. Youn-Jung concludes, "These findings provide sufficient evidence for developing standardized nursing practice guidelines that may improve patient safety and reduce hospital mortality in critically ill adults on ECMO." These findings pave way for development of multifaceted interventions to enhance quality of life in patients discharged from ECMO and reduce healthcare expenditures.

Reference
Title of original paper: Factors associated with 30-day in-hospital mortality in critically ill adult patients receiving extracorporeal membrane oxygenation: A retrospective cohort study

Journal: Intensive & Critical Care Nursing

DOI: https://doi.org/10.1016/j.iccn.2023.103489

Media contact: 
Professor Youn-Jung Son, Chung-Ang University
[email protected]
Website: https://scholarworks.bwise.kr/cau/researcher-profile?ep=967

Sungki Shin
[email protected]
02-820-6614

About Chung-Ang University
Website: https://neweng.cau.ac.kr/index.do 

SOURCE Chung-Ang University