Extracorporeal Membrane Oxygenation As Circulatory Support in Adult Patients with Septic Shock: A Systematic Review

Overview

Journal J Crit Care Med (Targu Mures)

Publisher Sciendo

Specialty Critical Care

Date 2024 Aug 7

PMID 39109275

Authors

Muhammad Faisal Khan

Mohsin Nazir

Muhammad Khuzzaim Khan

Raj Kumar Rajendram

Faisal Shamim

Affiliations

Soon will be listed here.

Abstract

Introduction: The utilization of extracorporeal membrane oxygenation (ECMO) in adult patients experiencing septic shock is a subject of ongoing debate within the medical community. This study aims to comprehensively address this issue through a systematic review conducted in accordance with the PRISMA guidelines.

Aim Of Study: The primary objective of this study is to assess the outcomes of ECMO utilization in adult patients diagnosed with septic shock, thereby providing insights into the potential benefits and uncertainties associated with this treatment modality.

Materials And Methods: Our research encompassed a thorough search across electronic databases for relevant English-language articles published up until April 2023. The inclusion criteria were based on studies reporting on ECMO usage in adult patients with septic shock. Among the eligible studies meeting these criteria, a total of eleven were included in our analysis, involving a cohort of 512 patients. The mean age of the participants was 53.4 years, with 67.38% being male.

Results: In the pooled analysis, the mean survival rate following ECMO treatment was found to vary significantly across different ECMO modalities. Patients receiving venovenous-ECMO (VV-ECMO) and veno-venous-arterial ECMO (VVA-ECMO) demonstrated higher survival rates (44.5% and 44.4%, respectively) compared to those receiving venoarterial-ECMO (VA-ECMO) at 25% (p<0.05). A chi-square test of independence indicated that the type of ECMO was a significant predictor of survival (χ(2) = 6.63, p=0.036). Additionally, patients with septic shock stemming from respiratory failure demonstrated survival rates ranging from 39% to 70%. Predictors of mortality were identified as older age and the necessity for cardiopulmonary resuscitation (CPR).

Conclusions: In septic shock patients, ECMO outcomes align with established indications like respiratory and cardiogenic shock. VV-ECMO and VVA-ECMO suggest better prognoses, though the optimal mode remains uncertain. Patient selection should weigh age and CPR need. Further research is vital to determine ECMO's best approach for this population.

Citing Articles

Rising Above the Limits of Critical Care ECMO: A Narrative Review.

Bertini P, Marabotti A, Meani P, Sangalli F, Paternoster G Medicina (Kaunas). 2025; 61(2).

PMID: 40005292 PMC: 11857283. DOI: 10.3390/medicina61020174.

References

Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T . Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016; 42(5):889-896. DOI: 10.1007/s00134-016-4273-z. View

Perdue S, Poore B, Babu A, Stribling W . Successful use of extracorporeal membrane oxygenation support in severe septic shock with associated acute cardiomyopathy. J Card Surg. 2018; 33(1):50-52. DOI: 10.1111/jocs.13508. View

Wan X, Wang W, Liu J, Tong T . Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14:135. PMC: 4383202. DOI: 10.1186/1471-2288-14-135. View

MacLaren G, Butt W, Best D, Donath S . Central extracorporeal membrane oxygenation for refractory pediatric septic shock. Pediatr Crit Care Med. 2010; 12(2):133-6. DOI: 10.1097/PCC.0b013e3181e2a4a1. View

Le Gall A, Follin A, Cholley B, Mantz J, Aissaoui N, Pirracchio R . Veno-arterial-ECMO in the intensive care unit: From technical aspects to clinical practice. Anaesth Crit Care Pain Med. 2017; 37(3):259-268. DOI: 10.1016/j.accpm.2017.08.007. View

Krishnagopalan S, Kumar A, Parrillo J, Kumar A . Myocardial dysfunction in the patient with sepsis. Curr Opin Crit Care. 2002; 8(5):376-88. DOI: 10.1097/00075198-200210000-00003. View

Yeo H, Jeon D, Kim Y, Cho W, Kim D . Veno-veno-arterial extracorporeal membrane oxygenation treatment in patients with severe acute respiratory distress syndrome and septic shock. Crit Care. 2016; 20:28. PMC: 4748570. DOI: 10.1186/s13054-016-1205-9. View

Banjas N, Hopf H, Hanisch E, Friedrichson B, Fichte J, Buia A . ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period. J Intensive Care. 2019; 6:84. PMC: 6299557. DOI: 10.1186/s40560-018-0352-2. View

Vogel D, Murray J, Czapran A, Camporota L, Ioannou N, Meadows C . Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience. Perfusion. 2018; 33(1_suppl):57-64. DOI: 10.1177/0267659118766833. View

10.

Amos T, Bannon-Murphy H, Yeung M, Gooi J, Marasco S, Udy A . ECMO (extra corporeal membrane oxygenation) in major trauma: A 10 year single centre experience. Injury. 2021; 52(9):2515-2521. DOI: 10.1016/j.injury.2021.03.058. View

11.

Falk L, Hultman J, Broman L . Differential hypoxemia and the clinical significance of venous drainage position during extracorporeal membrane oxygenation. Perfusion. 2022; 38(4):818-825. DOI: 10.1177/02676591221090667. View

12.

Cheng A, Sun H, Lee C, Ko W, Tsai P, Chuang Y . Survival of septic adults compared with nonseptic adults receiving extracorporeal membrane oxygenation for cardiopulmonary failure: a propensity-matched analysis. J Crit Care. 2013; 28(4):532.e1-10. DOI: 10.1016/j.jcrc.2012.11.021. View

13.

Huang C, Tsai Y, Tsai P, Ko W . Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2012; 146(5):1041-6. DOI: 10.1016/j.jtcvs.2012.08.022. View

14.

Vincent J, Brochard L . Do we need randomized clinical trials in extracorporeal respiratory support? We are not sure. Intensive Care Med. 2017; 43(12):1869-1871. DOI: 10.1007/s00134-017-4930-x. View

15.

Lee K, Cho C, Lee N, Choi G, Cho Y, Kim J . Extracorporeal membrane oxygenation support for refractory septic shock in liver transplantation recipients. Ann Surg Treat Res. 2017; 93(3):152-158. PMC: 5597539. DOI: 10.4174/astr.2017.93.3.152. View

16.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

17.

Han L, Zhang Y, Zhang Y, Wu W, He P . Risk factors for refractory septic shock treated with VA ECMO. Ann Transl Med. 2019; 7(18):476. PMC: 6803222. DOI: 10.21037/atm.2019.08.07. View

18.

Kyun Ro S, Kim W, Lim J, Yoo J, Hong S, Kim J . Extracorporeal life support for adults with refractory septic shock. J Thorac Cardiovasc Surg. 2018; 156(3):1104-1109.e1. DOI: 10.1016/j.jtcvs.2018.03.123. View

19.

Brechot N, Luyt C, Schmidt M, Leprince P, Trouillet J, Leger P . Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013; 41(7):1616-26. DOI: 10.1097/CCM.0b013e31828a2370. View

20.

Davis A, Carcillo J, Aneja R, Deymann A, Lin J, Nguyen T . American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017; 45(6):1061-1093. DOI: 10.1097/CCM.0000000000002425. View