Highlights
- •We compared the outcomes of immunocompetent patients, chronically immunosuppressed patients, and acutely immunosuppressed patients who were placed on ECMO at our institution.
- •There was no significant difference in ECMO, 30-day, 90-day, or one-year survival between immunocompetent patients, chronically immunosuppressed patients, and acutely immunosuppressed patients, suggesting that select immunosuppressed patients may be eligible for ECMO therapy.
- •Acutely immunosuppressed patients were at higher risk of developing new infections on ECMO, suggesting that infection control on ECMO is important in acutely immunosuppressed patients.
Abstract
Introduction
Immunosuppressed hosts represent a growing group of patients who suffer acute respiratory
failure and may be considered for therapies such as extracorporeal membrane oxygenation
(ECMO).
Objectives
We conducted this retrospective study to determine whether acutely or chronically
immunosuppressed patients placed on ECMO for cardiac and/or respiratory failure in
our institution have different outcomes than immunocompetent patients placed on ECMO
in our institution.
Methods
Adult patients placed on ECMO between June 31, 2010 and July 7, 2021 were identified
within an IRB-approved database. Data was retrospectively extracted from the database
and patients’ medical records. Patients who survived ECMO decannulation were sub-grouped
by the presence of acute or chronic immunosuppression, defined by the use of high-dose
steroids or immunosuppressive agents for greater than four weeks prior to ECMO initiation.
We analyzed and compared baseline characteristics and clinical outcomes using chi-squared
tests for categorical variables and a one-way analysis of variance (ANOVA) for continuous
variables.
Results
385 patients were included in this study, with 39 identified as chronically immunosuppressed,
49 as acutely immunosuppressed, and 297 as immunocompetent. There was no statistical
difference in ECMO survival (respectively 54%, 59%, 65% p = 0.359) or 30-day survival (33%, 51%, 48% p = 0.149) for chronically immunosuppressed, acutely immunosuppressed, and immunocompetent,
respectively. There were significant differences in rates of pre-ECMO COVID infection
(p<0.001), coronary artery disease (p<0.001), smoking (p = 0.003), and acute kidney injury (p = 0.032). Acutely immunosuppressed patients had the highest rates of new infections
during ECMO (p = 0.006).
Conclusion
When compared to immunocompetent patients, both acutely and chronically immunosuppressed
patients had no significant difference in ECMO survival or 30-day survival. Acutely
immunosuppressed patients had less comorbidities than chronically immunosuppressed
patients, but they were more commonly infected during ECMO. ECMO may still be a valuable
tool in appropriately selected patients with refractory respiratory or cardiac failure.
Keywords
Abbreviations:
ECMO (Extracorporeal membrane oxygenation), COVID-19 (Coronavirus disease-2019), ARDS (Acute respiratory distress syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 17, 2022
Accepted:
December 1,
2022
Received in revised form:
November 30,
2022
Received:
July 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
