oa Reduction in ECMO mortality following increased experience: The Dubai Hospital experience

Background: Survival following extracorporeal membrane oxygenation (ECMO) has steadily improved over the past decade owing to better knowledge and training.^1,2 The objective of our study is to identify the predictors and trend of in-hospital morbidity and mortality during our initial experience. Methods: After obtaining an DSREC (Dubai Scientific Research Ethics Committee) review and exemption, we collected the clinical data of patients from May 2013 to November 2016 and analyzed for baseline characteristics, indication, type, undergoing cardiopulmonary resuscitation (CPR) or not, duration of ECMO treatment, morbidity, and mortality. Results: A total of 24 adults received ECMO (18 M/6 F), of which 22 were supported with veno-arterial (VA) ECMO and the remaining were converted from VA to veno-venous (VV) ECMO during the course of their treatment. There were 8 (6 M/2 F) survivors (30%) with two bridged for left ventricular assist device (LVAD) and one for heart transplant. The mortality pattern as shown in Figure 1 shows a consistent improvement of more than 50% from mid-2015. Weaning was overall successful in 30% of surgical and 38% of medical patients. CPR was necessary in 12 patients, none from the survivor group. The minimum to maximum duration of ECMO was 53–483 hours in the survivors versus 2–528 hours in the non-survivors, of which 8 (50%) survived less than 24 hours on ECMO. The most frequent complications were bleeding from catheterization or surgical site (58.3%), renal failure (29.1%), GI bleeding (20.8%), and leg ischemia (12.5%). Two patients had raised bilirubin and one altered response to medication, resulting in hypertension and bleeding.³ The percentage among survivors to non-survivors with reference to bleeding was 38% vs. 69%, leg ischemia 0% vs.18%, renal failure 12.5% vs. 37.5%, and GI bleeding 12.5% vs. 31.2%.Figure 1.  Mortality rate of ECMO patients at Dubai Hospital from 2013 to 2016.

Conclusions: In spite of a steep learning curve, a remarkable improvement in the reduction of mortality was achieved during the latter half of the term possibly due to better understanding, education, and training. The survival during this interval compared well with the previous results and Extracorporeal Life Support Organization (ELSO) reports.^4,5 The percentage of complications and the number of patients requiring CPR were less in the survivors' group, indicating that early referral and prevention of ECMO complications are equally important. These two elements could be the key to our success in the management of these patients.