Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points
Background: Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. Research Question: We aimed to characterize the reasons for death in patien...
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Elsevier
2025-03-01
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| Series: | CHEST Critical Care |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949788424000686 |
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| author | Renata P. Lerner, MD, PhD Amira Mohamed, MD Annette Ilg, MD Raghu R. Seethala, MD Alison Witkin, MD Jerome Crowley, MD Anthony Carlese, MD Michelle Ng Gong, MD, MPH Iris Aimlin, MD Jen-Ting Chen, MD, MS David Furfaro, MD, MPH Brian O’Gara, MD Ryan Gardner, MD Malorie Butera, RN Shahzad Shaefi, MD, MPH Daniel Knox, MD Daniel Gutteridge, MD, MBA Christie Horner, BSN, CCRN Anthony Manasia, MD, MPH Nidhi Kavi, MD Marjan Rahmanian, MD Ari Moskowitz, MD, MPH |
| author_facet | Renata P. Lerner, MD, PhD Amira Mohamed, MD Annette Ilg, MD Raghu R. Seethala, MD Alison Witkin, MD Jerome Crowley, MD Anthony Carlese, MD Michelle Ng Gong, MD, MPH Iris Aimlin, MD Jen-Ting Chen, MD, MS David Furfaro, MD, MPH Brian O’Gara, MD Ryan Gardner, MD Malorie Butera, RN Shahzad Shaefi, MD, MPH Daniel Knox, MD Daniel Gutteridge, MD, MBA Christie Horner, BSN, CCRN Anthony Manasia, MD, MPH Nidhi Kavi, MD Marjan Rahmanian, MD Ari Moskowitz, MD, MPH |
| author_sort | Renata P. Lerner, MD, PhD |
| collection | DOAJ |
| description | Background: Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. Research Question: We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO. Study Design and Methods: This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States. Results: We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites. Interpretation: This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy. |
| format | Article |
| id | doaj-art-5bb6eefce6a04e8686c0d2fb42d75320 |
| institution | OA Journals |
| issn | 2949-7884 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | CHEST Critical Care |
| spelling | doaj-art-5bb6eefce6a04e8686c0d2fb42d753202025-08-20T02:04:01ZengElsevierCHEST Critical Care2949-78842025-03-013110011410.1016/j.chstcc.2024.100114Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home PointsRenata P. Lerner, MD, PhD0Amira Mohamed, MD1Annette Ilg, MD2Raghu R. Seethala, MD3Alison Witkin, MD4Jerome Crowley, MD5Anthony Carlese, MD6Michelle Ng Gong, MD, MPH7Iris Aimlin, MD8Jen-Ting Chen, MD, MS9David Furfaro, MD, MPH10Brian O’Gara, MD11Ryan Gardner, MD12Malorie Butera, RN13Shahzad Shaefi, MD, MPH14Daniel Knox, MD15Daniel Gutteridge, MD, MBA16Christie Horner, BSN, CCRN17Anthony Manasia, MD, MPH18Nidhi Kavi, MD19Marjan Rahmanian, MD20Ari Moskowitz, MD, MPH21Montefiore Medical Center, The Bronx; CORRESPONDENCE TO: Renata P. Lerner, MD, PhDMontefiore Medical Center, The BronxBrigham and Women’s Hospital, Boston, MABrigham and Women’s Hospital, Boston, MAMassachusetts General Hospital, Boston, MAMassachusetts General Hospital, Boston, MAMontefiore Medical Center, The BronxMontefiore Medical Center, The BronxMontefiore Medical Center, The BronxUniversity of San Francisco Medical Center, San Francisco, CABeth Israel Deaconess Medical Center, Boston, MABeth Israel Deaconess Medical Center, Boston, MABeth Israel Deaconess Medical Center, Boston, MABeth Israel Deaconess Medical Center, Boston, MABeth Israel Deaconess Medical Center, Boston, MAIntermountain Health, Salt Lake City, UTIntermountain Health, Salt Lake City, UTIntermountain Health, Salt Lake City, UTMount Sinai Medical Center, New York, NYMount Sinai Medical Center, New York, NYMontefiore Medical Center, The BronxMontefiore Medical Center, The BronxBackground: Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully. Research Question: We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO. Study Design and Methods: This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States. Results: We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites. Interpretation: This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy.http://www.sciencedirect.com/science/article/pii/S2949788424000686ECMOmortalitypalliative carevenoarterialvenovenous |
| spellingShingle | Renata P. Lerner, MD, PhD Amira Mohamed, MD Annette Ilg, MD Raghu R. Seethala, MD Alison Witkin, MD Jerome Crowley, MD Anthony Carlese, MD Michelle Ng Gong, MD, MPH Iris Aimlin, MD Jen-Ting Chen, MD, MS David Furfaro, MD, MPH Brian O’Gara, MD Ryan Gardner, MD Malorie Butera, RN Shahzad Shaefi, MD, MPH Daniel Knox, MD Daniel Gutteridge, MD, MBA Christie Horner, BSN, CCRN Anthony Manasia, MD, MPH Nidhi Kavi, MD Marjan Rahmanian, MD Ari Moskowitz, MD, MPH Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points CHEST Critical Care ECMO mortality palliative care venoarterial venovenous |
| title | Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points |
| title_full | Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points |
| title_fullStr | Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points |
| title_full_unstemmed | Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points |
| title_short | Causes of Death Among Patients Supported by Extracorporeal Membrane OxygenationTake-Home Points |
| title_sort | causes of death among patients supported by extracorporeal membrane oxygenationtake home points |
| topic | ECMO mortality palliative care venoarterial venovenous |
| url | http://www.sciencedirect.com/science/article/pii/S2949788424000686 |
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