• Tone Bull Enger, Alois Philipp, Matthias Lubnow, Marcus Fischer, Daniele Camboni, Dirk Lunz, Thomas Bein, and Thomas Müller.
• 1Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 2Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany. 3Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. 4Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
• Crit. Care Med. 2017 Oct 1; 45 (10): 1718-1725.

ObjectivesTo assess long-term survival in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation and explore risk factors for long-term mortality.DesignSingle-center prospective cohort study.SettingUniversity Hospital Regensburg, Germany.PatientsAll primary cases supported with veno-venous extracorporeal membrane oxygenation from 2007 to 2016 (n = 553).InterventionsNone.Measurements And Main ResultsPatients were followed until January 2017. Long-term survival and predictors of long-term mortality were assessed using Kaplan-Meier survival analyses and Cox proportional hazards modeling, respectively. Two hundred eighty-six patients (52%) died during follow-up (mean follow-up 4.8 yr). Two hundred seventeen patients (39%) died during hospitalization, whereas another 69 patients (12%) died during later follow-up. Among hospital survivors, the 1-month, 3-month, 1-year, and 5-year survival rates were 99%, 95%, 86%, and 76%, respectively. Higher age, immunocompromised status, and higher Sequential Organ Failure Assessment scores were associated with long-term mortality, whereas patients with out-of-center cannulation showed improved long-term survival. Due to nonproportional hazards over time, the analysis was repeated for hospital survivors only (n = 336). Only age and immunocompromised state remained significant predictors of late mortality among hospital survivors. Lower Glasgow Outcome Scale at hospital discharge and the University Hospital Regensburg pre-extracorporeal membrane oxygenation score for predicting hospital mortality in veno-venous extracorporeal membrane oxygenation patients before extracorporeal membrane oxygenation initiation were associated with late mortality in hospital survivors (p < 0.001).ConclusionsWhereas acute illness factors may be important in prediction of hospital outcomes in veno-venous extracorporeal membrane oxygenation patients, they do not determine late mortality in hospital survivors. Preexisting morbidity and functional ability at hospital discharge may be important determinants of long-term survival in veno-venous extracorporeal membrane oxygenation patients.

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