Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment

Hyoungnae Kim, Jin Hyuk Paek, Joo Han Song, Hajeong Lee, Jong Hyun Jhee, Seohyun Park, Hae Ryong Yun, Youn Kyung Kee, Seung Hyeok Han, Tae Hyun Yoo, Shin Wook Kang, Sejoong Kim, Jung Tak Park

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique for patients with circulatory or pulmonary failure. Frequently, large-volume fluid resuscitation is needed to ensure sufficient extracorporeal blood flow in patients initiating ECMO. However, excessive overhydration is known to increase mortality in critically ill patients. Therefore, in order to define a tolerant volume range in patients undergoing ECMO treatment, the association between cumulative fluid balance (CFB) and outcome was evaluated in patients undergoing ECMO. Methods: This retrospective multicenter cohort study was conducted with 723 patients who underwent ECMO in three tertiary care hospitals between 2005 and 2016. CFB was calculated as total fluid input minus total fluid output during the first 3 days from ECMO initiation. The patients were divided into groups that initiated ECMO owing to cardiovascular disease (CVD)-related or non-cardiovascular disease (non-CVD)-related causes. The primary endpoint was mortality within 90 days after ECMO commencement. Results: Totals of 406 and 317 patients were included in the CVD and non-CVD groups, respectively. In the CVD group, the mean age was 58.4 ± 17.7 years, and 68.2% were male. The mean age was 55.7 ± 15.7 years, and 65.3% were male in the non-CVD group. The median CFB values were 64.7 and 53.5 ml/kg in the CVD and non-CVD groups, respectively. Multivariable analysis using Cox proportional hazards models revealed a significantly increased risk of 90-day mortality in patients with higher CFB values in both the CVD and non-CVD groups. However, the risks were elevated only in the two CFB quartile groups with the largest CFB amounts. Cubic spline models showed that mortality risk began to increase significantly when CFB was 82.3 ml/kg in the CVD group. In patients with respiratory diseases, the mortality risk increase was significant for those with CFB levels above 189.6 ml/kg. Conclusions: Mortality risk did not increase until a certain level of fluid overload was reached in patients undergoing ECMO. Adequate fluid resuscitation is critical to improving outcomes in these patients.

Original languageEnglish
Article number270
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - 2018 Oct 27

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Extracorporeal Membrane Oxygenation
Water-Electrolyte Balance
Cardiovascular Diseases
Mortality
Therapeutics
Resuscitation
Tertiary Healthcare
Proportional Hazards Models
Tertiary Care Centers
Critical Illness
Multicenter Studies
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Kim, H., Paek, J. H., Song, J. H., Lee, H., Jhee, J. H., Park, S., ... Park, J. T. (2018). Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment. Critical Care, 22(1), [270]. https://doi.org/10.1186/s13054-018-2211-x
Kim, Hyoungnae ; Paek, Jin Hyuk ; Song, Joo Han ; Lee, Hajeong ; Jhee, Jong Hyun ; Park, Seohyun ; Yun, Hae Ryong ; Kee, Youn Kyung ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Kang, Shin Wook ; Kim, Sejoong ; Park, Jung Tak. / Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment. In: Critical Care. 2018 ; Vol. 22, No. 1.
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title = "Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment",
abstract = "Background: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique for patients with circulatory or pulmonary failure. Frequently, large-volume fluid resuscitation is needed to ensure sufficient extracorporeal blood flow in patients initiating ECMO. However, excessive overhydration is known to increase mortality in critically ill patients. Therefore, in order to define a tolerant volume range in patients undergoing ECMO treatment, the association between cumulative fluid balance (CFB) and outcome was evaluated in patients undergoing ECMO. Methods: This retrospective multicenter cohort study was conducted with 723 patients who underwent ECMO in three tertiary care hospitals between 2005 and 2016. CFB was calculated as total fluid input minus total fluid output during the first 3 days from ECMO initiation. The patients were divided into groups that initiated ECMO owing to cardiovascular disease (CVD)-related or non-cardiovascular disease (non-CVD)-related causes. The primary endpoint was mortality within 90 days after ECMO commencement. Results: Totals of 406 and 317 patients were included in the CVD and non-CVD groups, respectively. In the CVD group, the mean age was 58.4 ± 17.7 years, and 68.2{\%} were male. The mean age was 55.7 ± 15.7 years, and 65.3{\%} were male in the non-CVD group. The median CFB values were 64.7 and 53.5 ml/kg in the CVD and non-CVD groups, respectively. Multivariable analysis using Cox proportional hazards models revealed a significantly increased risk of 90-day mortality in patients with higher CFB values in both the CVD and non-CVD groups. However, the risks were elevated only in the two CFB quartile groups with the largest CFB amounts. Cubic spline models showed that mortality risk began to increase significantly when CFB was 82.3 ml/kg in the CVD group. In patients with respiratory diseases, the mortality risk increase was significant for those with CFB levels above 189.6 ml/kg. Conclusions: Mortality risk did not increase until a certain level of fluid overload was reached in patients undergoing ECMO. Adequate fluid resuscitation is critical to improving outcomes in these patients.",
author = "Hyoungnae Kim and Paek, {Jin Hyuk} and Song, {Joo Han} and Hajeong Lee and Jhee, {Jong Hyun} and Seohyun Park and Yun, {Hae Ryong} and Kee, {Youn Kyung} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Sejoong Kim and Park, {Jung Tak}",
year = "2018",
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doi = "10.1186/s13054-018-2211-x",
language = "English",
volume = "22",
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Kim, H, Paek, JH, Song, JH, Lee, H, Jhee, JH, Park, S, Yun, HR, Kee, YK, Han, SH, Yoo, TH, Kang, SW, Kim, S & Park, JT 2018, 'Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment', Critical Care, vol. 22, no. 1, 270. https://doi.org/10.1186/s13054-018-2211-x

Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment. / Kim, Hyoungnae; Paek, Jin Hyuk; Song, Joo Han; Lee, Hajeong; Jhee, Jong Hyun; Park, Seohyun; Yun, Hae Ryong; Kee, Youn Kyung; Han, Seung Hyeok; Yoo, Tae Hyun; Kang, Shin Wook; Kim, Sejoong; Park, Jung Tak.

In: Critical Care, Vol. 22, No. 1, 270, 27.10.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment

AU - Kim, Hyoungnae

AU - Paek, Jin Hyuk

AU - Song, Joo Han

AU - Lee, Hajeong

AU - Jhee, Jong Hyun

AU - Park, Seohyun

AU - Yun, Hae Ryong

AU - Kee, Youn Kyung

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Kim, Sejoong

AU - Park, Jung Tak

PY - 2018/10/27

Y1 - 2018/10/27

N2 - Background: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique for patients with circulatory or pulmonary failure. Frequently, large-volume fluid resuscitation is needed to ensure sufficient extracorporeal blood flow in patients initiating ECMO. However, excessive overhydration is known to increase mortality in critically ill patients. Therefore, in order to define a tolerant volume range in patients undergoing ECMO treatment, the association between cumulative fluid balance (CFB) and outcome was evaluated in patients undergoing ECMO. Methods: This retrospective multicenter cohort study was conducted with 723 patients who underwent ECMO in three tertiary care hospitals between 2005 and 2016. CFB was calculated as total fluid input minus total fluid output during the first 3 days from ECMO initiation. The patients were divided into groups that initiated ECMO owing to cardiovascular disease (CVD)-related or non-cardiovascular disease (non-CVD)-related causes. The primary endpoint was mortality within 90 days after ECMO commencement. Results: Totals of 406 and 317 patients were included in the CVD and non-CVD groups, respectively. In the CVD group, the mean age was 58.4 ± 17.7 years, and 68.2% were male. The mean age was 55.7 ± 15.7 years, and 65.3% were male in the non-CVD group. The median CFB values were 64.7 and 53.5 ml/kg in the CVD and non-CVD groups, respectively. Multivariable analysis using Cox proportional hazards models revealed a significantly increased risk of 90-day mortality in patients with higher CFB values in both the CVD and non-CVD groups. However, the risks were elevated only in the two CFB quartile groups with the largest CFB amounts. Cubic spline models showed that mortality risk began to increase significantly when CFB was 82.3 ml/kg in the CVD group. In patients with respiratory diseases, the mortality risk increase was significant for those with CFB levels above 189.6 ml/kg. Conclusions: Mortality risk did not increase until a certain level of fluid overload was reached in patients undergoing ECMO. Adequate fluid resuscitation is critical to improving outcomes in these patients.

AB - Background: Extracorporeal membrane oxygenation (ECMO) is a cardiorespiratory support technique for patients with circulatory or pulmonary failure. Frequently, large-volume fluid resuscitation is needed to ensure sufficient extracorporeal blood flow in patients initiating ECMO. However, excessive overhydration is known to increase mortality in critically ill patients. Therefore, in order to define a tolerant volume range in patients undergoing ECMO treatment, the association between cumulative fluid balance (CFB) and outcome was evaluated in patients undergoing ECMO. Methods: This retrospective multicenter cohort study was conducted with 723 patients who underwent ECMO in three tertiary care hospitals between 2005 and 2016. CFB was calculated as total fluid input minus total fluid output during the first 3 days from ECMO initiation. The patients were divided into groups that initiated ECMO owing to cardiovascular disease (CVD)-related or non-cardiovascular disease (non-CVD)-related causes. The primary endpoint was mortality within 90 days after ECMO commencement. Results: Totals of 406 and 317 patients were included in the CVD and non-CVD groups, respectively. In the CVD group, the mean age was 58.4 ± 17.7 years, and 68.2% were male. The mean age was 55.7 ± 15.7 years, and 65.3% were male in the non-CVD group. The median CFB values were 64.7 and 53.5 ml/kg in the CVD and non-CVD groups, respectively. Multivariable analysis using Cox proportional hazards models revealed a significantly increased risk of 90-day mortality in patients with higher CFB values in both the CVD and non-CVD groups. However, the risks were elevated only in the two CFB quartile groups with the largest CFB amounts. Cubic spline models showed that mortality risk began to increase significantly when CFB was 82.3 ml/kg in the CVD group. In patients with respiratory diseases, the mortality risk increase was significant for those with CFB levels above 189.6 ml/kg. Conclusions: Mortality risk did not increase until a certain level of fluid overload was reached in patients undergoing ECMO. Adequate fluid resuscitation is critical to improving outcomes in these patients.

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