Extracorporeal membrane oxygenation in adult patients with septic shock

Background: In adult patients suffering from septic shock, supportive therapy with extracorporeal membrane oxygenation (ECMO) is still controversially discussed and only few data have been published on this subject. Methods: We retrieved the records of all septic shock patients treated with ECMO in the Department of Anesthesia and Perioperative Medicine of the Asklepios Klinik in Langen between 2011 and 2016. The primary endpoint was survival at the time of hospital discharge. The following variables were analysed: Age, ECMO mode, demographics, comorbidities, source of infection, type of pathogen, SAPS II, SOFA score, pre-ECMO pH-value, lactate value, base excess, norepinephrine dose and PaO2/FiO(2) at onset of ECMO treatment. Results: A total of 36 patients with a median age of 57 years (25th to 75th percentile 47-71,5) were analysed. The overall survival at hospital discharge was 42%. The main site of infection was the lung (75%), followed by the abdomen (19%). Only age was a predictor of hospital mortality. The optimal cut-off value for hospital survival was an age of 59 years (area under the curve (AUC) 0.83, p <0,001). Conclusions: The overall survival rate to hospital discharge remains low. In our patients with refractory septic shock, we could not find any predictors of hospital mortality except for an age older than 59 years.