Tuberc Respir Dis.  2019 Jul;82(3):251-260. 10.4046/trd.2018.0061.

Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study

• Kim WY
• Park S
• Kim HJ
• Baek MS
• Chung CR
• Park SH
• Kang BJ
• Oh JY
• Cho WH
• Sim YS
• Cho YJ
• Park S
• Kim JH
• Hong SB

• KMID: 2450903
• DOI: http://doi.org/10.4046/trd.2018.0061

Abstract

BACKGROUND
Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients.
METHODS
This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48).
RESULTS
Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support.
CONCLUSION
Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

Keyword

Extracorporeal Membrane Oxygenation; Respiratory Distress Syndrome, Adult; Respiration, Artificial; Retrospective Studies; Multicenter Studies as Topic

MeSH Terms

Adult
Anoxia
Carbon Dioxide
Extracorporeal Membrane Oxygenation*
Humans
Intensive Care Units
Korea
Lung
Mortality
Multicenter Studies as Topic
Multivariate Analysis
Oxygen
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Retrospective Studies*
Ventilation
Ventilators, Mechanical
Carbon Dioxide
Oxygen

Figure

• 

  Figure 1 Illustration of a study flow diagram. ECMO: extracorporeal membrane oxygenation; BTT: bridge to transplant; VA: venoarterial; COPD: chronic obstructive pulmonary disease; ILD: interstitial lung disease; ARDS: acute respiratory distress syndrome.

• 

  Figure 2 Kaplan–Meier survival curves of the patients under study. ECMO: extracorporeal membrane oxygenation.

• 

  Figure 3 Serial changes in tidal volume (A), respiratory rate (B), positive end-expiratory pressure (PEEP) (C), peak inspiratory pressure (PIP) (D), dynamic driving pressure (E), and fraction of inspired oxygen (FiO2) (F) in the extended group (dark line) and the conventional group (gray line) during the 24-hour study period. Data is presented as a median value (interquartile range). *p<0.05. †p=0.13. ECMO: extracorporeal membrane oxygenation.

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