Prognosis of Patients on Extracorporeal Membrane Oxygenation plus Continuous Arteriovenous Hemofiltration

Background: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as those with life-threatening respiratory failure orpost-cardiotomy cardiogenic shock. Patients on ECMO with acute renal failure have high mortality rates. This study identifies specific predictors of hospital mortality for patients receiving ECMO and continuous arteriovenoushemofiltration (CAVH).Methods: This study reviewed the medical records of 123 critically ill patients onE C M O p l u s C AV H a t a c a r d i o v a s c u l a r s u r g i c a l i n t e n s i v e c a r e u n i t(CVSICU) at a tertiary care university hospital between March 2003 andAugust 2010. Patient baseline, clinical, and laboratory data were collectedretrospectively as survival predicators.Results: The overall mortality rate was 85.4%. The most common conditions requiring ECMO plus CAVH were cardiogenic shock and oliguria. The AcutePhysiology and Chronic Health Evaluation II (APACHE II) score and organsystem failure (OSF) score both indicated good discriminative power (areaunder the receiver operating characteristic curve [AUROC] 0.812 0.048and 0.758 0.057, respectively). Multiple logistic regression analysis indicated that age, mean arterial pressure, and OSF score on day 1 of ECMOplus CAVH were independent risk factors for hospital mortality. Cumulativesurvival rates at the 6-month follow-up differed significantly (p < 0.001)between those with an OSF score ≤ 4 vs. those with an OSF score > 4.Conclusions: During ECMO plus CAVH support, both the OSF and APACHE II scoresshowed good discriminative power in predicting hospital mortality for thesepatients.