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Global Trends in Extracorporeal Membranous Oxygenation Use and Survival of Patients With Influenza-Associated Illness.
de St Maurice, Annabelle M; Bridges, Brian C; Rycus, Peter T; Fonnesbeck, Christopher J; Fleming, Geoffrey M; Halasa, Natasha B.
  • de St Maurice AM; 1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 2Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, MI. 3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
Pediatr Crit Care Med ; 17(9): 876-83, 2016 09.
Article en En | MEDLINE | ID: mdl-27427879
ABSTRACT

OBJECTIVES:

To determine the overall use of extracorporeal membranous oxygenation for influenza-associated illness and describe risk factors associated with mortality in these patients.

DESIGN:

Retrospective multicenter cohort analysis.

SETTING:

The international Extracorporeal Life Support Organization database was queried for patients with influenza-associated illness on extracorporeal membranous oxygenation from 1992 to 2014. PATIENTS In total, 1,654 patients with influenza-associated illness on extracorporeal membranous oxygenation.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Demographic and clinical data collected included age, type of support, duration of support, type of microbial codetection, complications, and survival status at discharge. The primary outcome of interest was survival to hospital discharge. From 1992 to 2014, 1,688 (3%) of the 61,336 extracorporeal membranous oxygenation runs were due to influenza-associated illness reflecting 1,654 unique patients 30 (2%) were neonates, 521 (31%) were pediatric patients, and 1,103 (67%) were adults. Extracorporeal membranous oxygenation use for influenza-associated illness increased from 1992 to 2014, with a marked increase in use after the 2009 H1N1 pandemic. Survival to hospital discharge of patients with influenza-associated illness on extracorporeal membranous oxygenation was 63% and was not affected by bacterial codetection. However, when patients with Staphylococcus aureus codetection were compared with those with another bacterial codetection, their survival to hospital discharge was significantly lower (52% vs 67%; p < 0.01). In a logistic regression model, the effect of S. aureus on in-hospital mortality varied by age group, with younger patients with S. aureus having increased in-hospital mortality.

CONCLUSIONS:

Extracorporeal membranous oxygenation use for individuals with influenza increased over time, particularly after the 2009 H1N1 pandemic, most notably among older adults. Survival to hospital discharge for patients with influenza on extracorporeal membranous oxygenation was slightly higher than survival to hospital discharge for respiratory illness due to any cause. Bacterial codetection was common among patients with influenza on extracorporeal membranous oxygenation and was associated with increased days on extracorporeal membranous oxygenation but not increased mortality. Only S. aureus codetection in children was associated with increased in-hospital mortality.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Oxigenación por Membrana Extracorpórea / Gripe Humana Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Aged80 / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Año: 2016 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Oxigenación por Membrana Extracorpórea / Gripe Humana Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Aged80 / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Año: 2016 Tipo del documento: Article