Outcomes of patients with respiratory failure declined for extracorporeal membrane oxygenation: a prospective observational study.

Devenir des patient·es atteint·es d’insuffisance respiratoire n’ayant pas pu recevoir une oxygénation par membrane extracorporelle : une étude observationnelle prospective.
Humans Extracorporeal Membrane Oxygenation Treatment Outcome Prospective Studies COVID-19 Respiratory Insufficiency / therapy Retrospective Studies
extracorporeal membrane oxygenation outcome referral pattern respiratory failure

Journal

Canadian journal of anaesthesia = Journal canadien d'anesthesie
ISSN: 1496-8975
Titre abrégé: Can J Anaesth
Pays: United States
ID NLM: 8701709

Informations de publication

Date de publication:
07 2023
Historique:
received: 18 05 2022
accepted: 28 11 2022
revised: 28 11 2022
medline: 27 7 2023
pubmed: 7 6 2023
entrez: 6 6 2023
Statut: ppublish

Résumé

Descriptive information on referral patterns and short-term outcomes of patients with respiratory failure declined for extracorporeal membrane oxygenation (ECMO) is lacking. We conducted a prospective single-centre observational cohort study of ECMO referrals to Toronto General Hospital (receiving hospital) for severe respiratory failure (COVID-19 and non-COVID-19), between 1 December 2019 and 30 November 2020. Data related to the referral, the referral decision, and reasons for refusal were collected. Reasons for refusal were grouped into three mutually exclusive categories selected a priori: "too sick now," "too sick before," and "not sick enough." In declined referrals, referring physicians were surveyed to collect patient outcome on day 7 after the referral. The primary study endpoints were referral outcome (accepted/declined) and patient outcome (alive/deceased). A total of 193 referrals were included; 73% were declined for transfer. Referral outcome was influenced by age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95 to 0.96; P < 0.01) and involvement of other members of the ECMO team in the discussion (OR, 4.42; 95% CI, 1.28 to 15.2; P < 0.01). Patient outcomes were missing in 46 (24%) referrals (inability to locate the referring physician or the referring physician being unable to recall the outcome). Using available data (95 declined and 52 accepted referrals; n = 147), survival to day 7 was 49% for declined referrals (35% for patients deemed "too sick now," 53% for "too sick before," 100% for "not sick enough," and 50% for reason for refusal not reported) and 98% for transferred patients. Sensitivity analysis setting missing outcomes to directional extreme values retained robustness of survival probabilities. Nearly half of the patients declined for ECMO consideration were alive on day 7. More information on patient trajectory and long-term outcomes in declined referrals is needed to refine selection criteria. RéSUMé: OBJECTIF: On manque d’informations descriptives sur les schémas de références et les devenirs à court terme des patient·es atteint·es d’insuffisance respiratoire n’ayant pas pu recevoir une oxygénation par membrane extracorporelle (ECMO). MéTHODE: Nous avons réalisé une étude de cohorte observationnelle prospective monocentrique sur les références vers l’ECMO à l’Hôpital général de Toronto (hôpital d’accueil) pour insuffisance respiratoire grave (COVID-19 et non-COVID-19), entre le 1

Autres résumés

Type: Publisher (fre)
RéSUMé: OBJECTIF: On manque d’informations descriptives sur les schémas de références et les devenirs à court terme des patient·es atteint·es d’insuffisance respiratoire n’ayant pas pu recevoir une oxygénation par membrane extracorporelle (ECMO). MéTHODE: Nous avons réalisé une étude de cohorte observationnelle prospective monocentrique sur les références vers l’ECMO à l’Hôpital général de Toronto (hôpital d’accueil) pour insuffisance respiratoire grave (COVID-19 et non-COVID-19), entre le 1

Identifiants

DOI: 10.1007/s12630-023-02501-7 PMID: 37280459 PMC: PMC10243882
pubmed: 37280459
doi: 10.1007/s12630-023-02501-7
pii: 10.1007/s12630-023-02501-7
pmc: PMC10243882
doi:

Types de publication

Observational Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1226-1233

Informations de copyright

© 2023. Canadian Anesthesiologists' Society.

Références

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Auteurs

Ricardo Teijeiro-Paradis (R)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

Jasmine Grenier (J)

Department of Critical Care, Scarborough Health Network, Scarborough, ON, Canada.

Martin Urner (M)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

Ghislaine Douflé (G)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.

Andrew Steel (A)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.

Marcelo Cypel (M)

Department of Surgery, University of Toronto, Toronto, ON, Canada.

Shaf Keshavjee (S)

Department of Surgery, University of Toronto, Toronto, ON, Canada.

Margaret Herridge (M)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.

Ewan Goligher (E)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.

John Granton (J)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.

Niall Ferguson (N)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.

Eddy Fan (E)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.

Lorenzo Del Sorbo (L)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. lorenzo.delsorbo@uhn.ca.
Department of Medicine, University of Toronto, Toronto, ON, Canada. lorenzo.delsorbo@uhn.ca.
Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. lorenzo.delsorbo@uhn.ca.
Division of Respirology & Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada. lorenzo.delsorbo@uhn.ca.
ORCID: 0000-0003-3294-9838

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Procédures de chirurgie opératoire › Circulation extracorporelle › Oxygénation extracorporelle sur oxygénateur à membrane › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Troubles respiratoires › Insuffisance respiratoire › Outcomes of patients with respiratory failure...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Outcomes of patients with respiratory failure...