Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation

摘要

Objective: As survival with extracorporeal membrane oxygenation (ECMO) therapy improves, it is important to study patients who do not survive secondary to withdrawal of life-sustaining therapy (WLST). The purpose of the present study was to determine the population and clinical characteristics of those who experienced short latency to WLST. Design: Retrospective cohort study. Setting: Single academic hospital center. Participants: Adult ECMO patients. Interventions: None. Measurements and Main Results: During the study period, 150 patients (mean age 54.8 +/- 15.9 y, 43.3 female) underwent ECMO (80 venoarterial ECMO and 20 venovenous ECMO). Seventy-three (48.7) had WLST from ECMO support (median five days), and 33 of those (45.2) had early WLST (<= five days). Patients who underwent WLST were older (60.3 +/- 15.3 y v 49.6 +/- 14.7 y; p < 0.001) than those who did not undergo WLST and had greater body mass index (31.7 +/- 7.6 kg/m(2) v 28.3 +/- 5.5 kg/m(2); p = 0.002), longer ECMO duration (six v four days; p = 0.01), and higher Acute Physiology and Chronic Health Evaluation (25 v 21; p < 0.001) and Sequential Organ Failure Assessment (12 v 11; p = 0.037) scores. Family request frequently (91.7) was cited as part of the WLST decision. WLST patients experienced more chaplaincy (89 v 65; p < 0.001), palliative care consults (53.4 v 29.9; p = 0.003), and code status change (do not resuscitate: 83.6 v 7.8; p < 0.001). Conclusions: Nearly 50 of ECMO patients underwent WLST, with approximately 25 occurring in the first 72 hours. These patients were older, sicker, and experienced a different clinical context. Unlike with other critical illnesses, neurologic injury was not a primary reason for WLST in ECMO patients. (C) 2021 Elsevier Inc. All rights reserved.