Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database
- Thomas V. BroganAffiliated withDivision of Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine Email author
- , Ravi R. ThiagarajanAffiliated withDepartment of Cardiology and Pediatrics, Children’s Hospital, Harvard Medical School
- , Peter T. RycusAffiliated withExtracorporeal Life Support Organization
- , Robert H. BartlettAffiliated withDepartment of Surgery, University of Michigan Health System
- , Susan L. BrattonAffiliated withDepartment of Pediatrics, Primary Children’s Medical Center, University of Utah
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To evaluate clinical and treatment factors for patients recorded in the Extracorporeal Life Support Organization (ELSO) registry and survival of adult extracorporeal membrane oxygenation (ECMO) respiratory failure patients.
Design and patients
Retrospective case review of the ELSO registry from 1986–2006. Data were analyzed separately for the entire time period and the most recent years (2002–2006).
Of 1,473 patients, 50% survived to discharge. Median age was 34 years. Most patients (78%) were supported with venovenous ECMO. In a multi-variate logistic regression model, pre-ECMO factors including increasing age, decreased weight, days on mechanical ventilation before ECMO, arterial blood pH ≤ 7.18, and Hispanic and Asian race compared to white race were associated with increased odds of death. For the most recent years (n = 600), age and PaCO2 ≥ 70 compared to PaCO2 ≤ 44 were also associated with increased odds of death. The two diagnostic categories acute respiratory failure and asthma compared to ARDS were associated with decreased odds of mortality as was venovenous compared to venoarterial mode. CPR and complications while on ECMO including circuit rupture, central nervous system infarction or hemorrhage, gastrointestinal or pulmonary hemorrhage, and arterial blood pH < 7.2 or >7.6 were associated with increased odds of death.
Survival among this cohort of adults with severe respiratory failure supported with ECMO was 50%. Advanced patient age, increased pre-ECMO ventilation duration, diagnosis category and complications while on ECMO were associated with mortality. Prospective studies are needed to evaluate the role of this complex support mode.
KeywordsExtracorporeal Life Support Organization (ELSO) Acute respiratory distress syndrome (ARDS) Pneumonia Survival Complications
- Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database
Intensive Care Medicine
Volume 35, Issue 12 , pp 2105-2114
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- Extracorporeal Life Support Organization (ELSO)
- Acute respiratory distress syndrome (ARDS)
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- Author Affiliations
- 1. Division of Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
- 2. Department of Cardiology and Pediatrics, Children’s Hospital, Harvard Medical School, Boston, MA, USA
- 3. Extracorporeal Life Support Organization, Ann Arbor, MI, USA
- 4. Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
- 5. Department of Pediatrics, Primary Children’s Medical Center, University of Utah, Salt Lake City, UT, USA