The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure

摘要

Abstract BackgroundThe Extracorporeal Life Support Organization (ELSO) has suggested that extracorporeal membrane oxygenation (ECMO) patients should be managed by a multidisciplinary team. However, there are limited data on the impact of ECMO team on the outcomes of patients with severe acute respiratory failure.MethodsAll consecutive patients with severe acute respiratory failure who underwent ECMO for respiratory support from January 2012 through December 2016 were divided into the pre-ECMO team period (before January 2014, n =?70) and the post-ECMO team period (after January 2014, n =?46). Clinical characteristics and outcomes were compared between the two groups.ResultsThe mortality rates in the intensive care unit (72.9 vs. 50.0%, P =?0.012) and hospital (75.7 vs. 52.2%, P =?0.009) were significantly decreased in the post-ECMO team period compared to the pre-ECMO team period. The median duration of ECMO support was not different between the two periods. However, the proportion of patients successfully weaned off ECMO was higher in the post-ECMO team period (42.9 vs. 65.2%, P =?0.018). During ECMO support, the incidence of cannula problems (32.9 vs. 15.2%, P =?0.034) and cardiovascular events (88.6 vs. 65.2%, P =?0.002) was reduced after implementation of the ECMO team. The 1-year mortality was significantly different between the pre-ECMO team and post-ECMO team periods (37.8 vs. 14.3%, P =?0.005).ConclusionAfter implementing a multidisciplinary ECMO team, survival rate in patients treated with ECMO for severe acute respiratory failure was significantly improved.