Mortality high among ECMO patients requiring emergency laparotomy
While survival to discharge is possible, mortality is high among patients on extracorporeal membrane oxygenation (ECMO) needing emergency laparotomy, reports a new study.
Researchers conducted a single-centre, retrospective, observational cohort study including 355 ECMO patients. All participants needed to undergo laparotomy while attached to the machine. Study outcomes included the prevalence of emergency laparotomy, mortality risk, acute mortality rate and survival to discharge, among others.
Of the participants, 13 required laparotomies (mean age, 48.6±12.5 years; 30.8 percent female) while 342 (mean age, 44.8±14.1 years; 43.6 percent female) did not, resulting in a prevalence rate of 3.7 percent.
All patients survived laparotomy, while five died during the overall ECMO duration. Of the six patients who were successfully decannulated, an additional two died. The overall mortality rate was 69 percent. Four patients survived to hospital discharge.
Multivariable logistic regression analysis yielded a final model with five independent variables: age, laparotomy, Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment (SOFA) score upon admission, and maximum SOFA score. This model demonstrated a good ability to distinguish between those who did and did not survive to discharge (p<0.001).
The final model yielded a sensitivity of 95.6 percent and a positive predictive value of 81.5 percent. It was able to correctly classify 79.9 percent of cases and could account for 15.2–23.1 percent of the variance in survival to discharge.