Intensive Care Medicine

, Volume 35, Issue 12, pp 2105–2114

Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database

  • Thomas V. Brogan
  • Ravi R. Thiagarajan
  • Peter T. Rycus
  • Robert H. Bartlett
  • Susan L. Bratton
Original

DOI: 10.1007/s00134-009-1661-7

Cite this article as:
Brogan, T.V., Thiagarajan, R.R., Rycus, P.T. et al. Intensive Care Med (2009) 35: 2105. doi:10.1007/s00134-009-1661-7

Abstract

Objective

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).

Results

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.

Conclusions

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.

Keywords

Extracorporeal Life Support Organization (ELSO)Acute respiratory distress syndrome (ARDS)PneumoniaSurvivalComplications

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Thomas V. Brogan
    • 1
  • Ravi R. Thiagarajan
    • 2
  • Peter T. Rycus
    • 3
  • Robert H. Bartlett
    • 4
  • Susan L. Bratton
    • 5
  1. 1.Division of Critical Care Medicine, Department of PediatricsSeattle Children’s Hospital, University of Washington School of MedicineSeattleUSA
  2. 2.Department of Cardiology and PediatricsChildren’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Extracorporeal Life Support OrganizationAnn ArborUSA
  4. 4.Department of SurgeryUniversity of Michigan Health SystemAnn ArborUSA
  5. 5.Department of Pediatrics, Primary Children’s Medical CenterUniversity of UtahSalt Lake CityUSA