Experiencia en el manejo de terapia ECMO como factor de riesgo de mortalidad / Experience in the management of ECMO therapy as a mortality risk factor

Introducción. La membrana de oxigenación extracorpórea (ECMO) es un sistema que proporciona asistencia circulatoria y respiratoria a pacientes en fallo cardiaco o respiratorio refractarios al tratamiento convencional. Es una terapia con numerosas complicaciones asociadas y alta mortalidad. El manejo por equipos multidisciplinares y con experiencia aumenta la probabilidad de supervivencia. Objetivos. Evaluar y analizar el efecto de la curva de aprendizaje sobre la mortalidad. Métodos. Estudio retrospectivo y observacional de 31 pacientes, realizado desde enero de 2012 hasta diciembre de 2015. Los pacientes se agruparon en 2periodos que están divididos por la instauración de un protocolo ECMO. Comparamos las variables cuantitativas realizando la prueba U de Mann-Whitney; para las variables cualitativas categóricas empleamos la prueba Chi-cuadrado o el estadístico exacto de Fisher, según correspondiera. La curva de supervivencia se elaboró mediante el método de Kaplan-Meier y el análisis de la significación estadística mediante el test Log-rank. El análisis de los datos se realizó con el programa STATA 14. Resultados. En las curvas de supervivencia se muestra la tendencia a menor mortalidad en los pacientes del periodo posterior (p=0,0601). La tasa de mortalidad general en el periodo inicial fue mayor que en el periodo posterior (p=0,042). En otro análisis comparamos características de los 2grupos y concluimos que eran homogéneos. Conclusión. El grado de experiencia es un factor independiente para la mortalidad. La aplicación de un protocolo asistencial es fundamental para facilitar el manejo de la terapia ECMO (AU)

Introduction. The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. Objective. Our purpose is to evaluate and analyse the effect of the learning curve on mortality. Methods. Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. Results. Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. Conclusion. The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy (AU)

Experience in the management of ECMO therapy as a mortality risk factor. / Experiencia en el manejo de terapia ECMO como factor de riesgo de mortalidad.

INTRODUCTION: The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. OBJECTIVE: Our purpose is to evaluate and analyse the effect of the learning curve on mortality. METHODS: Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. RESULTS: Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. CONCLUSION: The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy.