Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study

Background: Extracorporeal membrane oxygenation (ECMO) life support has become an integral part of intensive care. The endotoxin activity assay (EAA) is a useful test to measure endotoxemia severity in whole blood. To date, no information is available regarding the EAA levels and their effect on cli...

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Autores principales:	Chen-Tse Lee, Chih-Hsien Wang, Wing-Sum Chan, Yun-Yi Tsai, Tzu-Jung Wei, Chien-Heng Lai, Ming-Jiuh Wang, Yih-Sharng Chen, Yu-Chang Yeh
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	critical care endotoxin extracorporeal membrane oxygenation (ECMO) survival infection Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/ba8bad7c8eb04ed4823a7c08f724c6d3
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spelling	oai:doaj.org-article:ba8bad7c8eb04ed4823a7c08f724c6d32021-12-01T13:31:22ZEndotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study2296-858X10.3389/fmed.2021.772413https://doaj.org/article/ba8bad7c8eb04ed4823a7c08f724c6d32021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.772413/fullhttps://doaj.org/toc/2296-858XBackground: Extracorporeal membrane oxygenation (ECMO) life support has become an integral part of intensive care. The endotoxin activity assay (EAA) is a useful test to measure endotoxemia severity in whole blood. To date, no information is available regarding the EAA levels and their effect on clinical outcomes in critically ill patients with ECMO support.Methods: This prospective observational pilot study enrolled adult critically ill patients with ECMO support from August 2019 to December 2020. The EAA levels were measured within 24 h (T1), and at 25–48 (T2), 49–72 (T3), and 73–96 h (T4) after ECMO initiation. This study primarily aimed to investigate the incidence of high EAA levels (≥0.6) at each time point. Subsequent exploratory analyses were conducted to compare the EAA levels of venoarterial ECMO (VA-ECMO) patients between 30-day survivors and non-survivors. Post-hoc analysis was performed to compare the clinical outcomes of VA-ECMO patients with elevated EAA levels at T3 (vs. T1) and those without elevated EAA levels.Results: A total of 39 VA-ECMO patients and 15 venovenous ECMO (VV-ECMO) patients were enrolled. At T1, the incidence of high EAA level (≥0.6) was 42% in VV-ECMO patients and 9% in VA-ECMO patients (P = 0.02). At T2, the incidence of high EAA level was 40% in VV-ECMO patients and 5% in VA-ECMO patients (P = 0.005). In VA-ECMO patients, EAA levels at T3 were significantly higher in 30-day non-survivors than in survivors (median [interquartile range]: 0.49 [0.37–0.93] vs. 0.31 [0.19–0.51], median difference 0.16 [95% confidence interval [CI], 0.02–0.31]; P = 0.024). Moreover, VA-ECMO patients with elevated EAA levels at T3 (vs. T1) had lower 30-day survival than patients without elevated EAA levels (39 vs. 83%, P = 0.026) and fewer ECMO free days by day 30 (median: 3 vs. 23 days, median difference 12 days [95% CI, 0–22]; P = 0.028).Conclusions: A certain proportion of patients experienced high EAA levels (≥0.6) after VV-ECMO or VA-ECMO initiation. VA-ECMO patients with an elevated EAA level at 49–72 h were associated with poor clinical outcomes.Chen-Tse LeeChih-Hsien WangWing-Sum ChanYun-Yi TsaiTzu-Jung WeiChien-Heng LaiMing-Jiuh WangYih-Sharng ChenYu-Chang YehFrontiers Media S.A.articlecritical careendotoxinextracorporeal membrane oxygenation (ECMO)survivalinfectionMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	critical care endotoxin extracorporeal membrane oxygenation (ECMO) survival infection Medicine (General) R5-920
spellingShingle	critical care endotoxin extracorporeal membrane oxygenation (ECMO) survival infection Medicine (General) R5-920 Chen-Tse Lee Chih-Hsien Wang Wing-Sum Chan Yun-Yi Tsai Tzu-Jung Wei Chien-Heng Lai Ming-Jiuh Wang Yih-Sharng Chen Yu-Chang Yeh Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
description	Background: Extracorporeal membrane oxygenation (ECMO) life support has become an integral part of intensive care. The endotoxin activity assay (EAA) is a useful test to measure endotoxemia severity in whole blood. To date, no information is available regarding the EAA levels and their effect on clinical outcomes in critically ill patients with ECMO support.Methods: This prospective observational pilot study enrolled adult critically ill patients with ECMO support from August 2019 to December 2020. The EAA levels were measured within 24 h (T1), and at 25–48 (T2), 49–72 (T3), and 73–96 h (T4) after ECMO initiation. This study primarily aimed to investigate the incidence of high EAA levels (≥0.6) at each time point. Subsequent exploratory analyses were conducted to compare the EAA levels of venoarterial ECMO (VA-ECMO) patients between 30-day survivors and non-survivors. Post-hoc analysis was performed to compare the clinical outcomes of VA-ECMO patients with elevated EAA levels at T3 (vs. T1) and those without elevated EAA levels.Results: A total of 39 VA-ECMO patients and 15 venovenous ECMO (VV-ECMO) patients were enrolled. At T1, the incidence of high EAA level (≥0.6) was 42% in VV-ECMO patients and 9% in VA-ECMO patients (P = 0.02). At T2, the incidence of high EAA level was 40% in VV-ECMO patients and 5% in VA-ECMO patients (P = 0.005). In VA-ECMO patients, EAA levels at T3 were significantly higher in 30-day non-survivors than in survivors (median [interquartile range]: 0.49 [0.37–0.93] vs. 0.31 [0.19–0.51], median difference 0.16 [95% confidence interval [CI], 0.02–0.31]; P = 0.024). Moreover, VA-ECMO patients with elevated EAA levels at T3 (vs. T1) had lower 30-day survival than patients without elevated EAA levels (39 vs. 83%, P = 0.026) and fewer ECMO free days by day 30 (median: 3 vs. 23 days, median difference 12 days [95% CI, 0–22]; P = 0.028).Conclusions: A certain proportion of patients experienced high EAA levels (≥0.6) after VV-ECMO or VA-ECMO initiation. VA-ECMO patients with an elevated EAA level at 49–72 h were associated with poor clinical outcomes.
format	article
author	Chen-Tse Lee Chih-Hsien Wang Wing-Sum Chan Yun-Yi Tsai Tzu-Jung Wei Chien-Heng Lai Ming-Jiuh Wang Yih-Sharng Chen Yu-Chang Yeh
author_facet	Chen-Tse Lee Chih-Hsien Wang Wing-Sum Chan Yun-Yi Tsai Tzu-Jung Wei Chien-Heng Lai Ming-Jiuh Wang Yih-Sharng Chen Yu-Chang Yeh
author_sort	Chen-Tse Lee
title	Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
title_short	Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
title_full	Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
title_fullStr	Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
title_full_unstemmed	Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
title_sort	endotoxin activity in patients with extracorporeal membrane oxygenation life support: an observational pilot study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ba8bad7c8eb04ed4823a7c08f724c6d3
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Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study

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