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Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis*

von Bahr, Viktor MD; Hultman, Jan MD, PhD; Eksborg, Staffan PhD; Frenckner, Björn MD, PhD; Kalzén, Håkan MD

doi: 10.1097/CCM.0000000000002078
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Objective: The use of extracorporeal membrane oxygenation in adults with respiratory failure and sepsis is steadily increasing, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 5-year survival rates and causes of late death in this group of patients.

Design: Single-center retrospective cohort study.

Setting: Karolinska University Hospital, Stockholm, Sweden.

Patients: Adult patients treated with extracorporeal membrane oxygenation for respiratory failure and sepsis between the service being established for adults in 1995 and December 2013.

Interventions: None.

Measurements and Main Results: Survival status was attained from a national Causes of Death registry. Minimal patient background data, along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 255 subjects, 64% survived to discharge. The median follow-up time in survivors was 4.4 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 5-year survival rate was 87% and was particularly beneficial in patients treated for infectious diseases (88–100%). Late deaths were seen in most diagnostic groups, but the Kaplan-Meier curves flattened out over time.

Conclusions: Extracorporeal membrane oxygenation treatment in adult patients with respiratory failure and sepsis can be lifesaving in appropriately selected patients. For patients who survive the first months after extracorporeal membrane oxygenation treatment, long-term survival seems good, especially in patients treated for infections.

Supplemental Digital Content is available in the text.

1Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.

2ECMO Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.

3Childhood Cancer Research Unit Q6:05, Department of Women’s and Children’s Health, Karolinska Institutet and Astrid Lindgren Children’s Hospital, Stockholm, Sweden.

4Department of Women’s and Children’s Health, Pediatric Surgery, Karolinska Institutet and Astrid Lindgren Children’s Hospital, Stockholm, Sweden.

*See also p. 361.

Conception and design: Dr. von Bahr, Dr. Kalzén, Dr. Frenckner, Dr. Hultman; Analysis and interpretation: Dr. von Bahr, Dr. Kalzén, Dr. Eksborg, Dr. Frenckner, Dr. Hultman; Drafting the manuscript for important intellectual content: Dr. von Bahr, Dr. Kalzén, Dr. Eksborg, Dr. Frenckner, Dr. Hultman.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The local Ethical Committee approved this study (No. 2013/2259-31/4). For this type of study formal consent is not required. On behalf of all authors, the corresponding author states that there is no conflict of interest.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: viktor.von.bahr@ki.se

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