The use of extracorporeal membrane oxygenation in human immunodeficiency virus-positive patients: a review of a multicenter database

Thomas Brogan*, Ravi R. Thiagarajan, Roberto Lorusso, D. Michael McMullan, Matteo Di Nardo, Mark T. Ogino, Heidi J. Dalton, Christopher R. Burke, Gerry Capatos

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Web of Science)

Abstract

Aim:

We chose to evaluate the survival of extracorporeal membrane oxygenation among patients with human immunodeficiency virus in a multicenter registry.

Methods:

Retrospective case review of the Extracorporeal Life Support Organization Registry respiratory failure of all patients with human immunodeficiency virus supported with extracorporeal membrane oxygenation.

Results:

A total of 126 patients were included. Survival to discharge was 36%. Eight infants were supported with extracorporeal membrane oxygenation and three (37.5%) survived to discharge. Respiratory extracorporeal membrane oxygenation was the primary indication (78%) with a 39% survival, while cardiac and extracorporeal cardiopulmonary resuscitation indications accounted for 16% and 6% of patients with survivals of 30% and 12.5%, respectively. These differences did not reach significance. There were no significant differences between survivors and non-survivors in demographic data, but non-survivors had significantly more non-human immunodeficiency virus pre-extracorporeal membrane oxygenation infections than survivors. There were no differences in other pre-extracorporeal membrane oxygenation supportive therapies, mechanical ventilator settings, or arterial blood gas results between survivors and non-survivors. The median duration of mechanical ventilation prior to cannulation was 52 (interquartile range: 13-140) hours, while the median duration of the extracorporeal membrane oxygenation exposure was 237 (interquartile range: 125-622) hours. Ventilator settings were significantly lower after 24 hours compared to pre-extracorporeal membrane oxygenation settings. Complications during extracorporeal membrane oxygenation exposure including receipt of renal replacement therapy, inotropic infusions, and cardiopulmonary resuscitation were more common among non-survivors compared to survivors. Central nervous system complications were rare.

Conclusion:

Survival among patients with human immunodeficiency virus infection who receive extracorporeal membrane oxygenation was less than 40%. Infections before extracorporeal membrane oxygenation cannulation occurred more often in non-survivors. The receipt of renal replacement therapy, inotropic infusions, or cardiopulmonary resuscitation during extracorporeal membrane oxygenation was associated with worse outcome.

Original languageEnglish
Pages (from-to)772-777
Number of pages6
JournalPerfusion
Volume35
Issue number8
Early online date6 Mar 2020
DOIs
Publication statusPublished - Nov 2020

Keywords

  • human immunodeficiency virus (HIV)
  • extracorporeal membrane oxygenation (ECMO)
  • extracorporeal life support (ECLS)
  • Pneumocystis jirovecii pneumonia (PJP)
  • Extracorporeal Life Support Organization (ELSO)
  • inotropes
  • cardiopulmonary resuscitation
  • renal replacement therapy
  • ACUTE RESPIRATORY-FAILURE
  • PNEUMOCYSTIS PNEUMONIA
  • LIFE-SUPPORT
  • HIV
  • THERAPY

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