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Observational Study
. 2014 Sep;40(9):1256-66.
doi: 10.1007/s00134-014-3360-2. Epub 2014 Jun 17.

Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation

Matthieu Schmidt  1 , Michael Bailey, Joshua Kelly, Carol Hodgson, D James Cooper, Carlos Scheinkestel, Vincent Pellegrino, Rinaldo Bellomo, David Pilcher
Affiliations
Observational Study

Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation

Matthieu Schmidt et al. Intensive Care Med. 2014 Sep.

Abstract

Purpose: To assess the relationship between early daily fluid balance (FB) and 90-day outcome in adult patients treated with extracorporeal membrane oxygenation (ECMO).

Design: Retrospective observational study.

Setting: Tertiary referral centre for ECMO.

Patients: 115 patients treated with ECMO for refractory heart failure and 57 patients treated with ECMO for refractory respiratory failure.

Methods: We analysed the association between early daily FB versus hospital and 90-day mortality using multivariable logistic regression model, Cox proportional-hazards model and propensity score.

Results: We obtained detailed demographic, clinical, and biochemical data, daily FB, and continuous renal replacement days. Fifty-seven per cent of patients had acute kidney injury (AKI) at ECMO initiation, and 60 % (n = 103) of patients received continuous renal replacement therapy (CRRT) during ECMO course, beginning at a median of 1 (0-3.5) days after ECMO initiation. Overall 90-day mortality was 24 %. Survivors exhibited lower daily FB from day 3 to day 5. After adjustments, Acute Physiology and Chronic Health Evaluation (APACHE) III, CRRT during the first 3 days, major bleeding event at day 1 and positive FB on day 3 were independent predictors of 90-day mortality. Positive FB at ECMO day 3 remained an independent predictor of hospital and 90-day mortality, regardless of the statistical model used or the inclusion of a propensity score to have positive FB.

Conclusions: Positive FB at ECMO day 3 is an independent predictor of 90-day mortality. Further interventional studies aimed at testing the value of strategy of tight control of FB during the early ECMO period are now warranted.

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Figures

Fig. 1
Fig. 1
Patient flow chart. ECMO extracorporeal membrane oxygenation, ICU intensive care unit, RRT renal replacement therapy
Fig. 2
Fig. 2
Graphical representation of mean daily fluid balance during ECMO according to day-90 outcome. White square day-90 survivors, black circle non-survivors. Data are mean ± standard deviation. *p < 0.01
See this image and copyright information in PMC

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