Extracorporeal membrane oxygenation in South Africa: Experience from a single centre in the private sector
Article Sidebar
Main Article Content
Abstract
Background. Extracorporeal membrane oxygenation (ECMO) is an advanced, resource-intensive technology used in a limited capacity in South Africa (SA). Minimal data on the use of ECMO in SA are available.
Objectives. To describe the indications, early outcome and comorbidities of patients placed on ECMO in the highest-volume ECMO centre in SA.
Methods. We performed a single-centre retrospective review of all adult patients supported with any form of ECMO from August 2016 to December 2018. Operative and clinical records were reviewed. The primary objective of this study was to review the outcome of patients placed on ECMO in the form of survival to hospital discharge. The secondary objectives were to identify population-specific comorbidities and indications for ECMO that could be associated with non-survival and to compare outcome with known risk scores in the form of the Respiratory ECMO Survival Prediction (RESP) and Survival After Venoarterial ECMO (SAVE) scores.
Results. One hundred and seven patients were identified. The primary indication for ECMO was respiratory support in 78 patients and cardiac support in 29 patients. Forty-seven patients were discharged from hospital, with a 44.0% overall survival rate. Gender (p=0.039), age (p=0.019) and hypertension (p=0.022) were associated with death in univariate logistic regression analysis. However, after adjusting for potential confounding in multivariate logistic regression analysis, the association was no longer significant. In the all respiratory support group, patients in risk class IV had better than predicted survival according to the RESP score, while risk classes I, II and III had worse than predicted survival. In the circulatory support group, all risk classes had worse than predicted survival according to the SAVE score.
Conclusion. We report ECMO outcomes in SA for the first time. We identified very high mortality rates for patients transferred on ECMO from other facilities and for patients converted from venovenous ECMO to venoarterial ECMO. Although our outcomes were comparable in some of the risk classes, further external validation of the SAVE and RESP scores will be needed to compare our outcomes with these scores.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
BroganTV,LequierL,LorussoR,MacLarenG,PeekG,eds.ExtracorporalLifeSupport: The ELSO Red Book. https://www.elso.org/ecmo-resources/6theditionredbook.aspx
Extracorporeal Life Support Organization. ECLS registry report & international summary
of statisitcs. 2023. https://www.elso.org/registry/internationalsummaryandreports.aspx
(accessed 6 November 2023).
Extracorporeal Life Support Organization (ELSO). Registry of active ELSO centers
using ECMO. https://www.elso.org/Registry.aspx (accessed 23 July 2021).
Braune S, Sieweke A, Brettner F, et al. The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): Multicentre case-control study. Intensive Care Med 2016;42(9):1437-1444. https://
doi.org/10.1007/s00134-016-4452-y5. Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: A systematic review and meta-analysis. Intensive Care Med 2016;42(12):1922-1934. https://doi.org/10.1007/s00134-016-4536-8
Hakim AH, Ahmad U, McCurry KR, et al. Contemporary outcomes of extracorporeal membrane oxygenation used as bridge to lung transplantation. Ann Thorac Surg 2018;106(1):192-198. https://doi.org/10.1016/J.ATHORACSUR.2018.02.036
Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure: The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med 2014;189(11):1374-1382. https://doi.org/10.1164/rccm.201311-2023OC
Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: The survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015;36(33):2246-2256. https://doi.org/10.1093/eurheartj/ehv194
Ahuja A, Shekar K. Patient selection for VV ECMO: Have we found the crystal ball? J Thorac Dis 2018;10(Suppl 17):S1979-S1981. https://doi.org/10.21037/JTD.2018.05.83
Hilder M, Herbstreit F, Adamzik M, et al. Comparison of mortality prediction models in acute respiratory distress syndrome undergoing extracorporeal membrane oxygenation and development of a novel prediction score: The PREdiction of Survival on ECMO Therapy-Score (PRESET-Score). Crit Care 2017;21(1):301. https://doi.org/10.1186/s13054-017-1888-6
Di Lascio G, Prifti E, Messai E, et al. Extracorporeal membrane oxygenation support for life-threatening acute severe status asthmaticus. Perfusion 2017;32(2):157-163. https://doi.org/10.1177/0267659116670481
BosS,VosR,vanRaemdonckDE,VerledenGM.Survivalinadultlungtransplantation: Where are we in 2020? Curr Opin Organ Transplant 2020;25(3):268-273. https://doi. org/10.1097/MOT.0000000000000753
Chambers DC, Perch M, Zuckermann A, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report – 2021; Focus on recipient characteristics. J Heart Lung Transplant 2021;40(10):1060-1072. https://doi. org/10.1016/j.healun.2021.07.021
Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading – a 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2017;36(10):1097-1103. https://doi.org/10.1016/J.HEALUN.2017.07.021
Hoetzenecker K, Benazzo A, Stork T, et al. Bilateral lung transplantation on intraoperative extracorporeal membrane oxygenator: An observational study. J Thorac Cardiovasc Surg 2020;160(1):320-327.e1. https://doi.org/10.1016/J. JTCVS.2019.10.155
Hoetzenecker K, Schwarz S, Muckenhuber M, et al. Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation. J Thorac Cardiovasc Surg 2018;155(5):2193- 2206.e3. https://doi.org/10.1016/J.JTCVS.2017.10.144
Falk L, Fletcher-Sandersjöö A, Hultman J, Broman LM. Conversion from venovenous to venoarterial extracorporeal membrane oxygenation in adults. Membranes (Basel) 2021;11(3):188. https://doi.org/10.3390/membranes11030188