Risk factors for refractory septic shock treated with VA ECMO

Abstract

Background: Refractory septic shock is a serious disorder with high mortality. There is currently limited evidence to support the use of extracorporeal membrane oxygenation (ECMO) in adult septic shock. We describe the outcome of patients with refractory septic shock in our hospital and try to identify prognostic factors. Methods: We studied a total of 23 (14 males and 9 females) refractory septic shock patients treated with venoarterial (VA) ECMO in our hospital. Clinical parameters of survival and death groups, laboratory parameters before and after ECMO placement were analyzed. Results: Eight patients were successfully weaned off ECMO and five patients were discharged. The sepsis-related organ failure assessment (SOFA) score and shock-to-ECMO interval before ECMO placement in the survival group were significantly lower than those in the death group (12.0 vs. 15.0, P=0.007; 23.5 vs. 42.2 h, P=0.037). The number of cases who had the normal range of ScvO2% between the survival group and the death group at 12 h (4 vs. 4, P=0.033), 18 h (5 vs. 7, P=0.016) and 24 h (5 vs. 9, P=0.043) during ECMO was significantly different. In univariate logistic regression analysis, the case of patients with normal central venous oxygen saturation (ScvO2) % at 12 h during ECMO [odds ratio (OR) 14.0, 95% confidence interval (CI): 1.200–163.367, P=0.035] was significantly associated with risk of the prognosis of patients. Conclusions: In adult refractory septic shock patients, ScvO2% at 12 h during ECMO may be a risk factor for patient prognosis.