Intensive Care Unit-Acquired Weakness in Patients With Extracorporeal Membrane Oxygenation Support: Frequency and Clinical Characteristics

Abstract

BackgroundIntensive care unit-acquired weakness (ICU-AW) is common in critical illness patients and is well described. Extracorporeal membrane oxygenation (ECMO) is used as a life-saving method and patients with ECMO support often suffer more risk factors of ICU-AW. However, information on the frequency and clinical characteristics of ICU-AW in patients with ECMO support is lacking. Our study aims to clarify the frequency and characteristics of ICU-AW in ECMO patients.MethodsWe conducted a retrospective study, ICU-AW was diagnosed when patients were discharged with a Medical Research Council (MRC) sum score <48. Clinical information was collected from the case report forms. Univariable analysis, LASSO regression analysis, and logistic regression analysis were used to analyze the clinical data of individuals.ResultsIn ECMO population, 40 (80%) patients diagnosed with ICU-AW. On univariable analysis, the ICU-AW group had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) [13.9 (6.5–21.3) versus 21.1 (14.3–27.9), p = 0.005], longer deep sedation time [2 (0–7) versus 6.5 (3–11), p = 0.005], longer mechanical ventilation time [6.8 (2.6–9.3) versus 14.3 (6.6–19.3), p = 0.008], lower lowest albumin [26.7 (23.8–29.5) versus 22.1 (18.5–25.7), p < 0.001]. The LASSO analysis showed mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHE II, and lowest albumin level were independent predictors of ICU-AW. To investigate whether ICU-AW occurs more frequently in the ECMO population, we performed a 1:1 matching with patients without ECMO and found there was no difference in the incidence of ICU-AW between the two groups. Logistic regression analysis of combined cohorts showed lowest albumin odds ratio (OR: 1.9, p = 0.024), deep sedation time (OR: 1.9, p = 0.022), mechanical ventilation time (OR: 2.0, p = 0.034), and APACHE II (OR: 2.3, p = 0.034) were independent risk factors of ICU-AW, but not ECMO.ConclusionThe ICU-AW was common with a prevalence of 80% in the ECMO population. Mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHE II, and lowest albumin level were risk factors of ICU-AW in ECMO population. The ECMO wasn’t an independent risk factor of ICU-AW.