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A Systematic Review of Preexisting Sepsis and ECMO

Sangli, Swathi S.*; Noronha, Shaun F.*; Mourad, Bashar; Jean, Raymonde; Bohman, John K.; Seelhammer, Troy G.

doi: 10.1097/MAT.0000000000000934
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We retrospectively reviewed all pertinent extracorporeal membrane oxygenation (ECMO) studies (January 1995 to September 2017) of adults with sepsis as a primary indication for intervention and its association with morbidity and mortality. Collected data included study type, ECMO configuration, outcomes, effect size, and other features. Advanced age was a risk factor for death. Compared with nonsurvivors, survivors had a lower median Sepsis-Related Organ Failure Assessment score on day 3 (15 vs. 18, p = 0.01). Biomarkers in survivors and nonsurvivors, respectively, were peak lactate (from two studies: 4.5 vs. 15.1 mmol/L, p = 0.03; 3.6 ± 3.7 vs. 3.3 ± 2.4 mmol/L, p = 0.850) and procalcitonin levels (41 vs. 164 ng/ml, p = 0.008). Bacteremia was associated with catheter colonization, and 90.5% of a group without bloodstream infections survived to discharge; ECMO weaning was possible for less than half the bloodstream infection group. Myocarditis portended favorable outcomes for patients with sepsis who received ECMO. Extracorporeal membrane oxygenation was used in immunosuppressed patients with refractory cardiopulmonary insufficiency from severe sepsis with successful weaning from ECMO for most patients. Overall survival varied substantially among studies (15.38–71.43%). Existing studies do not present well-defined patterns supporting use of ECMO in sepsis because of sample sizes and disparate study designs.

From the *Pulmonary and Critical Care Medicine, Mount Sinai St. Luke’s-Roosevelt

Pulmonary and Critical Care Medicine, Mount Sinai St. Luke’s, New York, New York

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.

Submitted for consideration May 2018; accepted for publication in revised form November 2018.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Troy G. Seelhammer, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: seelhammer.troy@mayo.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs