Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation.
J Cardiothorac Vasc Anesth
; 36(3): 833-839, 2022 03.
Article
em En
| MEDLINE
| ID: mdl-34088552
ABSTRACT
OBJECTIVE:
As survival with extracorporeal membrane oxygenation (ECMO) therapy improves, it is important to study patients who do not survive secondary to withdrawal of life-sustaining therapy (WLST). The purpose of the present study was to determine the population and clinical characteristics of those who experienced short latency to WLST.DESIGN:
Retrospective cohort study.SETTING:
Single academic hospital center.PARTICIPANTS:
Adult ECMO patients.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
During the study period, 150 patients (mean age 54.8 ± 15.9 y, 43.3% female) underwent ECMO (80% venoarterial ECMO and 20% venovenous ECMO). Seventy-three (48.7%) had WLST from ECMO support (median five days), and 33 of those (45.2%) had early WLST (≤five days). Patients who underwent WLST were older (60.3 ± 15.3 y v 49.6 ± 14.7 y; p < 0.001) than those who did not undergo WLST and had greater body mass index (31.7 ± 7.6 kg/m2v 28.3 ± 5.5 kg/m2; pâ¯=â¯0.002), longer ECMO duration (six v four days; pâ¯=â¯0.01), and higher Acute Physiology and Chronic Health Evaluation (25 v 21; p < 0.001) and Sequential Organ Failure Assessment (12 v 11; pâ¯=â¯0.037) scores. Family request frequently (91.7%) was cited as part of the WLST decision. WLST patients experienced more chaplaincy (89% v 65%; p < 0.001), palliative care consults (53.4% v 29.9%; pâ¯=â¯0.003), and code status change (do not resuscitate 83.6% v 7.8%; p < 0.001).CONCLUSIONS:
Nearly 50% of ECMO patients underwent WLST, with approximately 25% occurring in the first 72 hours. These patients were older, sicker, and experienced a different clinical context. Unlike with other critical illnesses, neurologic injury was not a primary reason for WLST in ECMO patients.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article