Original article
General thoracic
Survival Predictors in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation

https://doi.org/10.1016/j.athoracsur.2014.07.064Get rights and content

Background

Extracorporeal membrane oxygenation (ECMO) can be used as a salvage therapy, but the effectiveness is controversial. The aim of this study was to investigate the predictors of mortality and the influence of organ dysfunction scores in severe acute respiratory distress syndrome (ARDS) patients treated with ECMO.

Methods

The records of adult severe ARDS patients receiving ECMO support from May 2006 to December 2011 at Chang Gung Memorial Hospital were retrospectively analyzed.

Results

The records of 65 patients with severe ARDS who received venovenous ECMO were analyzed. The hospital survival rate was 47.7%. Survivors were younger than nonsurvivors (41.4 ± 15.4 versus 54.1 ± 16.9 years, respectively; p = 0.002) and had shorter duration of mechanical ventilation before ECMO (52.7 ± 51.1 versus 112.1 ± 101.0 hours, respectively; p = 0.01). Before ECMO, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction scores were significantly lower for survivors than for nonsurvivors. Mortality rate increased with rising predictive score. During 7 days of ECMO use, organ dysfunction scores were significantly lower for survivors than nonsurvivors.

Conclusions

Severe ARDS patients who are younger, have shorter duration of mechanical ventilation, and lower organ dysfunction scores before ECMO initiation have more favorable survival outcome. Early application of ECMO, especially if predictive score is below 2, may improve survival. Organ dysfunction scores before and during ECMO support are correlated with survival.

Section snippets

Patients

This was a retrospective study of severe ARDS patients who underwent ECMO in the medical and surgical intensive care units at a tertiary care referral center, Chang Gung Memorial Hospital, between May 2006 and December 2011. All patients had severe ARDS defined according to the Berlin definition with acute onset within 1 week, bilateral lung opacities on chest radiograph, no evidence of cardiac failure–related hydrostatic edema by echocardiography, and PaO2 to fraction of inspired oxygen (FiO2)

Patient Characteristics

In all, 81 patients with severe ARDS who received ECMO during the study period were included in the study. After excluding 16 patients (2 patients aged less than 18 years and 14 patients receiving venoarterial ECMO for intractable shock or heart failure), 65 patients were in the final analysis. Of those, 37 patients were successfully weaned from ECMO, and 31 patients survived; 28 patients could not be weaned from ECMO and did not survive (Fig 1). A summary of the demographic data and clinical

Comment

The effectiveness of ECMO for severe ARDS patients and life-threatening hypoxemia is controversial 2, 10. The present retrospective study demonstrated that the mortality rate was 52.3% for patients with severe ARDS who were treated with ECMO, higher than severe ARDS with a mortality rate of 45% according to the Berlin definition, with similar risk categories by PaO2:FiO2 ratio less than 100 mm Hg [1]. Survivors were younger and had significantly shorter duration of MV and lower APACH II, SOFA,

References (20)

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Drs Chiu and Tsai contributed equally to this article.

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