AUTHOR=Chen Xinyi , Lei Xiong , Xu Xin , Zhou Yu , Huang Man 

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.792201

DOI=10.3389/fmed.2022.792201

ISSN=2296-858X

ABSTRACT=Abstract
Background: ICU-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.
Methods: We conducted a retrospective study, ICU-AW was diagnosed when patients discharged with a Medical Research Council (MRC) sum score < 48. Clinical information was collected from the case report forms. Univariable analysis, LASSO regression analysis, logistic regression analysis were used to analyze clinical characteristics of individuals.
Results: In ECMO population, 40(80%) patients diagnosed with ICU-AW. On univariable analysis, ICU-AW group had higher APACHEII (13.9(6.5-21.3) versus 21.1(14.3-21.9), 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). LASSO analysis showed mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHEII 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 two groups. Logistic regression analysis of combined cohorts showed lowest albumin (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 APACHEII (OR 2.0, p=0.034) were independent risk factors of ICU-AW, but not ECMO.
Conclusion: ICU-AW was common with a prevalence of 80% in ECMO population. Mechanical ventilation time, deep sedation time, deep sedation time during ECMO operation, APACHEII and lowest albumin level were risk factors of ICU-AW in ECMO population. ECMO wasn’t an independent risk factor of ICU-AW.

Keywords: ECMO, ICU-acquired weakness, Mechanical ventilation, Sedation, ECMO complications