Artif Organs. 2021 Mar 16. doi: 10.1111/aor.13954. Online ahead of print.
BACKGROUND: Prognosis of patients suffering of acute respiratory distress syndrome (ARDS) is poor. This is especially true for immunosuppressed patients. If these patients should receive veno-venous extracorporeal membrane oxygenation (VV ECMO) is discussed controversial while evidence on this topic is sparse.
METHODS: We report retrospective data of a single-centre registry of patients with severe ARDS requiring ECMO support between 10/2010 and 06/2019. Patients were analysed by their status of immunosuppression. ECMO weaning success and hospital survival were analysed before and after propensity score matching (PSM). Moreover, ventilator free days (VFD) were compared.
RESULTS: A total of 288 patients were analysed (age 55years, 67%male), 88 (31%) presented with immunosuppression. Survival rates were lower in immunosuppressed patients (27%vs.53%, p<0.001 and 27%vs.48% after PSM, p=0.006). VFD (60 days) were lower for patients with immunosuppression (11.9vs.22.4, p<0.001) and immunosuppression was an independent predictor for mortality in multivariate analysis. Hospital survival was 20%, 14%, 35% and 46% for patients with oncological malignancies, solid organ transplantation, autoimmune diseases and HIV, respectively.
CONCLUSION: In this analysis immunosuppression was an independent predictor for mortality. However, there were major differences in the weaning and survival rates between the aetiologies of immunosuppression which should be considered in decision making.