Key result
Steroid use after respiratory ECMO weaning is linked to ~138% higher in-hospital mortality.
Why the study?
Successful weaning from ECMO does not necessarily imply patient survival, prompting evaluation of clinical factors associated with post-weaning mortality.
Cohort (n=441)
Yes
Hazard Ratio: 2.38 (95% CI 1.27–4.45)
p-value: p=0.007
Successful weaning from respiratory ECMO does not guarantee survival, with high subsequent mortality strongly associated with baseline lung disease reversibility, age, and acquired infections like sepsis.
Post-ECMO weaning mortality warrants vigilant monitoring; leaves open optimal risk-stratification strategies pending prospective validation.
Successful weaning from extracorporeal membrane oxygenation (ECMO) does not necessarily imply patient survival. We retrospectively analyzed 441 patients with acute respiratory failure from 16 hospitals in South Korea who underwent ECMO from January 2012 to December 2015. We evaluated the clinical factors associated with mortality after successful weaning from ECMO. Of all 441 patients, 245 (55.6%) were successfully weaned from ECMO. The majority of patients were initially supported with veno-venous ECMO (86.9%). Among those, 182 patients (41.3%) were discharged from hospital. Only 165 (37.4%) were alive after 6 months. Most cases of death occurred within the first month after weaning from ECMO (65%), and the most frequent reason for death was sepsis (76.2%). In the multivariate Cox regression analysis, patient age (per 10 years) (hazard ratio [HR] = 1.34, 95% CI = 1.12-1.61; p = 0.001), sequential organ failure assessment score (HR = 1.07, 95% CI = 1.02-1.13; p = 0.010), steroid (HR = 2.38, 95% CI = 1.27-4.45; p = 0.007), interstitial lung disease (HR = 1.20, 95% CI = 1.05-1.36; p = 0.006), and ECMO duration (per day) (HR = 1.02, 95% CI = 1.01-1.04; p < 0.001) were associated with the in-hospital mortality after weaning from ECMO. Furthermore, age (per 10 years) (HR = 1.45, 95% CI = 1.24-1.71; p < 0.001), steroid (HR = 2.19, 95% CI = 1.27-3.78; p = 0.005), and interstitial lung disease (HR = 1.16, 95% CI = 1.02-1.31; p = 0.021) were significantly associated with 6 month mortality. The prognosis after weaning from respiratory ECMO might be related to baseline conditions affecting the reversibility of the primary lung disease and to acquired infections.
No takes yet. Share an insight, caveat, or question.
Yeo et al. (2020) conducted a cohort in Acute respiratory failure requiring ECMO (n=441). Steroid use was evaluated on In-hospital mortality after weaning from ECMO (HR 2.38, 95% CI 1.27-4.45, p=0.007). In patients successfully weaned from respiratory ECMO, steroid use was significantly associated with increased in-hospital mortality (HR 2.38; 95% CI 1.27-4.45; p=0.007).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: