Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

Objective: Although the negative impact of immunosuppression on survival in patients with acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) is well known, short-term outcomes such as successful weaning rate from ECMO and subgroups benefit most from ECMO...

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Autores principales:	Chiao-Feng Cheng, You-Yi Chen, Ming-Chieh Shih, Yi-Min Huang, Li-Jung Tseng, Chien-Heng Lai, Ting-Yuan Lan, Cheng-Hsun Lu, Song-Chou Hsieh, Ko-Jen Li, Nai-Hsin Chi, Hsi-Yu Yu, Yih-Sharng Chen, Chih-Hsien Wang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ECMO extracorporeal life support pulmonary hemorrhage aspiration autoimmune diseases malignancy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/a14069d15c294f3cb264cd3d3ce9878e
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spelling	oai:doaj.org-article:a14069d15c294f3cb264cd3d3ce9878e2021-12-03T14:59:45ZExtracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study2296-858X10.3389/fmed.2021.755147https://doaj.org/article/a14069d15c294f3cb264cd3d3ce9878e2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.755147/fullhttps://doaj.org/toc/2296-858XObjective: Although the negative impact of immunosuppression on survival in patients with acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) is well known, short-term outcomes such as successful weaning rate from ECMO and subgroups benefit most from ECMO remain to be determined. The aims of this study were (1) to identify the association between immunocompromised status and weaning from ECMO in patients of ARDS, and (2) to identify subgroups of immunocompromised patients who may benefit from ECMO.Methods: This retrospective cohort study enrolled patients who received ECMO for ARDS from 2010 to 2020. Immunocompromised status was defined as having a hematological malignancy, active solid tumor, solid organ transplant, or autoimmune disease.Results: This study enrolled 256 ARDS patients who received ECMO, of whom 68 were immunocompromised. The multivariable analysis showed that immunocompromised status was not independently associated with failure to wean from ECMO. In addition, the patients with an autoimmune disease (14/24, 58.3%) and organ transplantation (3/3, 100%) had a numerically higher weaning rate from ECMO than other immunocompromised patients. For causes of ARDS, most patients with pulmonary hemorrhage (6/8, 75%) and aspiration (5/9, 55.6%) could be weaned from ECMO, compared to only a few of the patients with interstitial lung disease (2/9, 22.2%) and sepsis (1/4, 25%).Conclusions: Immunocompromised status was not an independent risk factor of failure to wean from ECMO in patients with ARDS. For patients with pulmonary hemorrhage and aspiration-related ARDS, ECMO may be beneficial as bridge therapy.Chiao-Feng ChengYou-Yi ChenMing-Chieh ShihYi-Min HuangLi-Jung TsengChien-Heng LaiTing-Yuan LanCheng-Hsun LuSong-Chou HsiehKo-Jen LiNai-Hsin ChiHsi-Yu YuYih-Sharng ChenChih-Hsien WangFrontiers Media S.A.articleECMOextracorporeal life supportpulmonary hemorrhageaspirationautoimmune diseasesmalignancyMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ECMO extracorporeal life support pulmonary hemorrhage aspiration autoimmune diseases malignancy Medicine (General) R5-920
spellingShingle	ECMO extracorporeal life support pulmonary hemorrhage aspiration autoimmune diseases malignancy Medicine (General) R5-920 Chiao-Feng Cheng You-Yi Chen Ming-Chieh Shih Yi-Min Huang Li-Jung Tseng Chien-Heng Lai Ting-Yuan Lan Cheng-Hsun Lu Song-Chou Hsieh Ko-Jen Li Nai-Hsin Chi Hsi-Yu Yu Yih-Sharng Chen Chih-Hsien Wang Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
description	Objective: Although the negative impact of immunosuppression on survival in patients with acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) is well known, short-term outcomes such as successful weaning rate from ECMO and subgroups benefit most from ECMO remain to be determined. The aims of this study were (1) to identify the association between immunocompromised status and weaning from ECMO in patients of ARDS, and (2) to identify subgroups of immunocompromised patients who may benefit from ECMO.Methods: This retrospective cohort study enrolled patients who received ECMO for ARDS from 2010 to 2020. Immunocompromised status was defined as having a hematological malignancy, active solid tumor, solid organ transplant, or autoimmune disease.Results: This study enrolled 256 ARDS patients who received ECMO, of whom 68 were immunocompromised. The multivariable analysis showed that immunocompromised status was not independently associated with failure to wean from ECMO. In addition, the patients with an autoimmune disease (14/24, 58.3%) and organ transplantation (3/3, 100%) had a numerically higher weaning rate from ECMO than other immunocompromised patients. For causes of ARDS, most patients with pulmonary hemorrhage (6/8, 75%) and aspiration (5/9, 55.6%) could be weaned from ECMO, compared to only a few of the patients with interstitial lung disease (2/9, 22.2%) and sepsis (1/4, 25%).Conclusions: Immunocompromised status was not an independent risk factor of failure to wean from ECMO in patients with ARDS. For patients with pulmonary hemorrhage and aspiration-related ARDS, ECMO may be beneficial as bridge therapy.
format	article
author	Chiao-Feng Cheng You-Yi Chen Ming-Chieh Shih Yi-Min Huang Li-Jung Tseng Chien-Heng Lai Ting-Yuan Lan Cheng-Hsun Lu Song-Chou Hsieh Ko-Jen Li Nai-Hsin Chi Hsi-Yu Yu Yih-Sharng Chen Chih-Hsien Wang
author_facet	Chiao-Feng Cheng You-Yi Chen Ming-Chieh Shih Yi-Min Huang Li-Jung Tseng Chien-Heng Lai Ting-Yuan Lan Cheng-Hsun Lu Song-Chou Hsieh Ko-Jen Li Nai-Hsin Chi Hsi-Yu Yu Yih-Sharng Chen Chih-Hsien Wang
author_sort	Chiao-Feng Cheng
title	Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
title_short	Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
title_full	Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
title_fullStr	Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
title_full_unstemmed	Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study
title_sort	extracorporeal membrane oxygenation in immunocompromised patients with acute respiratory distress syndrome—a retrospective cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a14069d15c294f3cb264cd3d3ce9878e
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Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

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