TY - JOUR
T1 - Outcome of extracorporeal membrane oxygenation support in patients with liver cirrhosis
T2 - A nationwide population-based cohort study
AU - Chou, An Hsun
AU - Wu, Victor Chien Chia
AU - Chen, Dong Yi
AU - Hung, Kuo Chun
AU - Chang, Shang Hung
AU - Chu, Pao Hsien
AU - Chen, Shao Wei
N1 - Publisher Copyright:
© 2020 European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is used for life support in patients with liver cirrhosis (LC). However, there have been no studies evaluating the outcome of ECMO support in patients with LC. METHODS: Using Taiwan’s National Health Insurance (NHI) database, we retrospectively evaluated patients with LC who received venovenous or veno-arterial ECMO between 1 January 2000 and 31 December 2013. The outcomes included ECMO-related complications, in-hospital mortality, all-cause mortality and long-term outcomes in patients with and without LC. RESULTS: A total of 7003 patients who received ECMO, of whom 233 (3.3%) had LC, were eligible for analysis. The LC patients who received ECMO support had a significantly higher risk of in-hospital mortality than the non-LC group (76.4% vs 60.7%; odds ratio 1.97; 95% confidence interval 1.44–2.70). The LC group also had a higher risk of complications, including de novo dialysis and massive blood transfusion with >10 units of red blood cells. Patients >_65 years of age, patients with respiratory disease, patients with hypoalbuminaemia and liver transplant patients had higher in-hospital and 1-year mortality. The mortality rates for patients with 2 or more risk factors were 90.3% and 95.8%, respectively. LC was associated with a higher incidence of all-cause mortality and liver-related outcomes during follow-up. CONCLUSIONS: Our findings raise questions regarding the utility of ECMO for LC patients, especially when >2 risk factors have been identified. ECMO support for LC patients should be used with caution and with careful patient selection.
AB - OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is used for life support in patients with liver cirrhosis (LC). However, there have been no studies evaluating the outcome of ECMO support in patients with LC. METHODS: Using Taiwan’s National Health Insurance (NHI) database, we retrospectively evaluated patients with LC who received venovenous or veno-arterial ECMO between 1 January 2000 and 31 December 2013. The outcomes included ECMO-related complications, in-hospital mortality, all-cause mortality and long-term outcomes in patients with and without LC. RESULTS: A total of 7003 patients who received ECMO, of whom 233 (3.3%) had LC, were eligible for analysis. The LC patients who received ECMO support had a significantly higher risk of in-hospital mortality than the non-LC group (76.4% vs 60.7%; odds ratio 1.97; 95% confidence interval 1.44–2.70). The LC group also had a higher risk of complications, including de novo dialysis and massive blood transfusion with >10 units of red blood cells. Patients >_65 years of age, patients with respiratory disease, patients with hypoalbuminaemia and liver transplant patients had higher in-hospital and 1-year mortality. The mortality rates for patients with 2 or more risk factors were 90.3% and 95.8%, respectively. LC was associated with a higher incidence of all-cause mortality and liver-related outcomes during follow-up. CONCLUSIONS: Our findings raise questions regarding the utility of ECMO for LC patients, especially when >2 risk factors have been identified. ECMO support for LC patients should be used with caution and with careful patient selection.
KW - Extracorporeal membrane oxygenation
KW - Liver cirrhosis
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85090079865&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezaa089
DO - 10.1093/ejcts/ezaa089
M3 - 文章
C2 - 32282923
AN - SCOPUS:85090079865
SN - 1010-7940
VL - 58
SP - 519
EP - 527
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 3
ER -