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

• Main Authors: Won-Young Kim, M.D., Ph.D., SeungYong Park, M.D., Ph.D., Hwa Jung Kim, M.D., Ph.D., Moon Seong Baek, M.D., Chi Ryang Chung, M.D., Ph.D., So Hee Park, M.D., Byung Ju Kang, M.D., Jin Young Oh, M.D., Ph.D., Woo Hyun Cho, M.D., Ph.D., Yun Su Sim, M.D., Ph.D., Young-Jae Cho, M.D., Ph.D., Sunghoon Park, M.D., Ph.D., Jung-Hyun Kim, M.D., Ph.D., Sang-Bum Hong, M.D., Ph.D.
• Format: Article
• Language: English
• Published: The Korean Academy of Tuberculosis and Respiratory Diseases 2019-07-01
• Series: Tuberculosis and Respiratory Diseases
• Subjects: extracorporeal membrane oxygenation; respiratory distress syndrome; adult; respiration; artificial; retrospective studies; multicenter studies as topic
• Online Access: https://www.e-trd.org/search.php?where=aview&id=10.4046/trd.2018.0061&code=0003TRD&vmode=FULL

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.