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

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) Pneumonia Survival Complications 

References

  1. 1.
    Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, Gerbode F (1972) Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome): use of Bramson membrane lung. N Engl J Med 286:629–634PubMedGoogle Scholar
  2. 2.
    Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Peirce EC 2nd, Thomas AN, Proctor HJ, Drinker PA, Pratt PC, Bagniewski A, Miller RG Jr (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196CrossRefPubMedGoogle Scholar
  3. 3.
    Peek GJ, Tirouvopaiti R, Firmin RK (2005) ECLS for adult respiratory failure: etiology and indications. In: Van Meurs K, Lally KP, Peek G, Zwischenberger JB (eds) ECMO Extracorporeal Cardiopulmonary Support in Critical Care, 3rd edn. Extracorporeal Life Support Organization, Ann Arbor, pp 393–402Google Scholar
  4. 4.
    Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, Iapichino G, Romagnoli G, Uziel L, Agostoni A, Koblow T, Damia G (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886CrossRefPubMedGoogle Scholar
  5. 5.
    Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr, Weaver LK, Dean NC, Thomas F, East TD, Pace NL, Suchyta MR, Beck E, Bombino M, Sittig DF, Bohm S, Hoffman B, Becks H, Butler S, Pearl J, Rasmusson B (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 149:295–305PubMedGoogle Scholar
  6. 6.
    Bartlett RH, Roloff DW, Cornell RG, Andrews AF, Dillon PW, Zwischenberger JB (1985) Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics 76:479–487PubMedGoogle Scholar
  7. 7.
    O’Rourke PP, Crone RK, Vacanti JP, Ware JH, Lillehei CW, Parad RB, Epstein MF (1989) Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics 84:957–963PubMedGoogle Scholar
  8. 8.
    UK Collaborative ECMO Trial Group (1996) UK Collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 348:75–82Google Scholar
  9. 9.
    Green TP, Timmons OD, Fackler JC, Moler FW, Thompson AE, Sweeney MF (1996) The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Crit Care Med 24:323–332CrossRefPubMedGoogle Scholar
  10. 10.
    Anderson HL 3rd, Delius RE, Sinard JM, McCurry KR, Shanley CJ, Chapman RA, Shapiro MB, Rodriquez JL, Bartlett RH (1992) Early experience with adult extracorporeal membrane oxygenation in the modern era. Ann Thorac Surg 53:553–563PubMedCrossRefGoogle Scholar
  11. 11.
    Kolla S, Awad SS, Rich PB, Schreiner RJ, Hirschl RB, Bartlett RH (1997) Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg 226:544–564CrossRefPubMedGoogle Scholar
  12. 12.
    Linden V, Palmer K, Reinhard J, Westman R, Ehren H, Granholm T, Freckner B (2000) High Survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 26:1630–1637CrossRefPubMedGoogle Scholar
  13. 13.
    Bartlett RH, Roloff DW, Custer JR, Younger JG, Hirschl RB (2000) Extracorporeal life support. The University of Michigan experience. JAMA 283:904–908CrossRefPubMedGoogle Scholar
  14. 14.
    Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, Haft JW, Swaniker F, Arbabi S, Hirschl RB, Bartlett RH (2004) Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 240:595–607PubMedGoogle Scholar
  15. 15.
    Beiderlinden M, Eikermann M, Boes T, Breitfeld C, Peters J (2006) Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange. Intensive Care Med 32:1627–1631CrossRefPubMedGoogle Scholar
  16. 16.
    Peek GJ, Moore HM, Moore N, Sosnowski AW, Firmin RK (1997) Extracorporeal membrane oxygenation for adult respiratory failure. Chest 112:759–764CrossRefPubMedGoogle Scholar
  17. 17.
    Pranikoff T, Hirschl RB, Steimle CN, Anderson HL 3rd, Bartlett RH (1997) Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure. Crit Care Med 25:28–32CrossRefPubMedGoogle Scholar
  18. 18.
    Lewandowski K, Rossaint R, Pappert D, Gerlach H, Slama KJ, Weidermann H, Frey DJ, Hoffmann O, Keske U, Falke KJ (1997) High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med 23:803–805CrossRefGoogle Scholar
  19. 19.
    Frenckner B, Palmer P, Linden V (2002) Extracorporeal respiratory support and minimally invasive ventilation in severe ARDS. Minerva Anestesiol 68:381–386PubMedGoogle Scholar
  20. 20.
    Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, Killer H, Mugford M, Thalanany M, Tiruvoipati R, Truesdale A, Wilson A (2006) CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res 6:163CrossRefPubMedGoogle Scholar
  21. 21.
    Peek G (2008) The CESAR Trial: conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure. Society of critical care medicine 37th critical care congress. Honolulu Hawaii. Society of critical care medicine. February 2, 2008Google Scholar
  22. 22.
    Cengiz P, Seidel K, Rycus PT, Brogan TV, Roberts JS (2005) Central nervous system complications during pediatric extracorporeal life support: incidence and risk factors. Crit Care Med 33:2817–2824CrossRefPubMedGoogle Scholar
  23. 23.
    Jardin F, Vieillard-Baron A (2007) Is there a safe plateau pressure in ARDS? The right heart knows. Intensive Care Med 33:444–447CrossRefPubMedGoogle Scholar
  24. 24.
    Toomasian JM, Snedecor SM, Cornell RG, Cilley RE, Bartlett RH (1988) National experience with extracorporeal membrane oxygenation for newborn respiratory failure. Data from 715 cases. ASAIO Trans 34:140–147CrossRefPubMedGoogle Scholar
  25. 25.
    O’Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM (2005) Measuring diagnoses: ICD code accuracy. Health Serv Res 40:1620–1639CrossRefPubMedGoogle Scholar

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

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