Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality

Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality

Ramanathan, K et al
Critical Care Medicine: May 2017 - Volume 45 - Issue 5 - p 814–821

Objectives: Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Design: Retrospective data analysis. 
Setting: Extracorporeal Life Support Organization Registry database. Patients: We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. 
Interventions: None. 
Measurements and Main Findings: One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal pneumonia, and advancing age. Type and duration of extracorporeal membrane oxygenation, neurologic complications, and presence of more than three complications on extracorporeal membrane oxygenation were also associated with higher mortality. 
Conclusions: The majority (66%) of adults with community-acquired pneumonia supported on extracorporeal membrane oxygenation survived. Certain potentially modifiable risk factors were associated with increased mortality.