Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database
- First Online:
- 2.1k Downloads
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
- 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.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.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.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
- 8.UK Collaborative ECMO Trial Group (1996) UK Collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 348:75–82Google Scholar
- 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
- 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.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