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Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment

Cited 10 time in Web of Science Cited 9 time in Scopus
Authors
Kim, Hyoungnae; Paek, Jin Hyuk; Song, Joo Han; Lee, Hajeong; Jhee, Jong Hyun; Park, Seohyun; Yun, Hae-Ryong; Kee, Youn Kyung; Han, Seung Han; Yoo, Tae-Hyun; Kang, Shin-Wook; Kim, Sejoong; Park, Jung Tak
Issue Date
2018-10-27
Publisher
BioMed Central
Citation
Critical Care, 22(1):270
Keywords
Acute respiratory distress syndromeCardiogenic shockExtracorporeal membrane oxygenationFluid balanceMortality
Abstract
Background
Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique for patients with circulatory or pulmonary failure. Frequently, large-volume fluid resuscitation is needed to ensure sufficient extracorporeal blood flow in patients initiating ECMO. However, excessive overhydration is known to increase mortality in critically ill patients. Therefore, in order to define a tolerant volume range in patients undergoing ECMO treatment, the association between cumulative fluid balance (CFB) and outcome was evaluated in patients undergoing ECMO.

Methods
This retrospective multicenter cohort study was conducted with 723 patients who underwent ECMO in three tertiary care hospitals between 2005 and 2016. CFB was calculated as total fluid input minus total fluid output during the first 3 days from ECMO initiation. The patients were divided into groups that initiated ECMO owing to cardiovascular disease (CVD)-related or non-cardiovascular disease (non-CVD)-related causes. The primary endpoint was mortality within 90 days after ECMO commencement.

Results
Totals of 406 and 317 patients were included in the CVD and non-CVD groups, respectively. In the CVD group, the mean age was 58.4 ± 17.7 years, and 68.2% were male. The mean age was 55.7 ± 15.7 years, and 65.3% were male in the non-CVD group. The median CFB values were 64.7 and 53.5 ml/kg in the CVD and non-CVD groups, respectively. Multivariable analysis using Cox proportional hazards models revealed a significantly increased risk of 90-day mortality in patients with higher CFB values in both the CVD and non-CVD groups. However, the risks were elevated only in the two CFB quartile groups with the largest CFB amounts. Cubic spline models showed that mortality risk began to increase significantly when CFB was 82.3 ml/kg in the CVD group. In patients with respiratory diseases, the mortality risk increase was significant for those with CFB levels above 189.6 ml/kg.

Conclusions
Mortality risk did not increase until a certain level of fluid overload was reached in patients undergoing ECMO. Adequate fluid resuscitation is critical to improving outcomes in these patients.
ISSN
1364-8535
Language
English
URI
https://hdl.handle.net/10371/146876
DOI
https://doi.org/10.1186/s13054-018-2211-x
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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