Experience in the management of ECMO therapy as a mortality risk factor

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 2 periods. 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 2 groups 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. (C) 2017 Sociedad Espanola de Anestesiologia, Reanimacian y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.