Outcomes of Adult Patients With Septic Shock Undergoing Extracorporeal Membrane Oxygenation Therapy

Extracorporeal membrane oxygenation (ECMO) has been shown to provide benefits in children, but not adults, with septic shock. This study described the clinical outcomes of adults in septic shock who underwent ECMO.

This study retrospectively investigated adults who were supported on venoarterial or venovenous modes of ECMO and who had septic shock at the time of cannulation from January 1, 2009 to December 31, 2016 at a quaternary medical center in the United States. The primary outcomes were rate of survival to hospital discharge and time to survival using Kaplan-Meier survival estimates. This study analyzed survival by mode, previous cardiac arrest, and timing of cannulation (<96 and ≥96 hours after admission to the intensive care unit). Secondary outcomes were complications and days of ECMO support, length of stay in the intensive care unit, and hospitalization days.

Of 243 patients supported on ECMO during this 7-year period, 32 met the criteria for septic shock, and the majority had a pulmonary source of infection (72%). The most common mode of support was venovenous ECMO (65%), and median ejection fraction was 51%. Median time on ECMO was 5.8 days (interquartile range, 2.6, 11.3 days). Survival to hospital discharge was 13 of 32 (41%), whereas median survival was 14.5 days (interquartile range, 5.2, 23.7 days). There was no statistically significant difference in survival by subgroup, including ECMO mode. Health care-associated infections were frequent (25%).

This cohort of patients undergoing ECMO had equivalent median survival compared with literature-based estimates of other cohorts of patients with septic shock.