Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange

Beiderlinden, Martin; Eikermann, Matthias; Boes, Tanja; Breitfeld, Christa; Peters, John

doi:10.1007/s00134-006-0262-y

Cited by 84 publications

(57 citation statements)

References 17 publications

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“…Complications are experienced by most of both cardiac and respiratory failure patients treated with ECMO, and patients with poor outcomes associated with worse outcome. 3,6,24,28,29 In our sample, mean age was significantly greater for patients who had a poor outcome in the total sample and cardiac subgroups, and age remained significantly associated with outcome for the cardiac subgroup in the regression analysis. We found that days of mechanical ventilator support trended higher in patients with a poor outcome (3 days vs 2 days), but was not significantly different between outcome groups either in the total sample or the cardiac subgroup.…”

Section: Resultsmentioning

confidence: 56%

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Guttendorf¹,

Boujoukos²,

Ren³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the medical indications for the use of extracorporeal membrane oxygenation (ECMO ACNP-BCBackground Extracorporeal membrane oxygenation (ECMO) is used for critically ill patients when conventional treatments for cardiac or respiratory failure are unsuccessful. Objectives To describe patient and treatment characteristics and discharge outcome for ECMO patients, determine which characteristics are associated with good (survival) versus poor (death before hospital discharge) outcomes, and compare characteristics of patients with cardiac versus respiratory failure indicating ECMO. Methods Single-center, retrospective review of all adult patients treated with ECMO from 2005 through 2009. Results A total of 212 patients received ECMO for cardiac (n = 126) or respiratory (n = 86) failure. Mean age was 51 (SD, 14.5) years; support duration was 135 (SD, 149) hours. Survival to discharge was 33% overall; 50% for respiratory indication and 21% for cardiac indication patients. Patients with poor outcomes were older (53 vs 47 years, P = .007), more likely to require cardiovascular support before ECMO (99% vs 91%; P = .02), and had more transfusions (48 vs 24 units, P = .005) and complications (99% vs 87%; P < .001) than did patients with good outcomes. For cardiac patients, older age was associated with poor outcome (poor, 55 vs good, 48 years; P = .01). For respiratory patients, poor outcome was associated with more ventilator days before ECMO (poor, 6 vs good, 3; P = .01), higher peak inspiratory pressure (poor, 39 vs good, 35 cm H 2 O; P = .02), and lower pulmonary compliance (poor, 19 vs good, 25 mL/cm H 2 O; P = .008). Conclusions Patients with respiratory indications for ECMO experienced better survival than did cardiac patients. Increasing age was associated with poor outcome. Complications, regardless of ECMO indication, were common and associated with poor outcome.

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Section: Resultsmentioning

confidence: 56%

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Guttendorf¹,

Boujoukos²,

Ren³

et al. 2014

American Journal of Critical Care

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“…Ten studies fulfilled the inclusion criteria, including four RCTs (19)(20)(21)(22) and six observational studies (14,(23)(24)(25)(26)(27). No SYSTEMATIC REVIEW SYSTEMATIC REVIEW pediatric trials met the inclusion criteria, and, therefore, only adult patients were included in all analyses.…”

Section: Literature Searchmentioning

confidence: 99%

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

et al. 2014

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Rationale: Extracorporeal life support (ECLS) for acute respiratory failure has increased as a result of technological advancements and promising results from recent studies as compared with historical trials.Objectives: Systematically review the effect of ECLS compared with mechanical ventilation on mortality, length of stay, and adverse events in respiratory failure.Methods: Data sources included were MEDLINE, EMBASE, and CENTRAL (through to October 2013). Any randomized controlled trial (RCT) or observational study comparing ECLS to mechanical ventilation in adults was used. Two authors independently abstracted the data. Our primary outcome was mortality. Secondary outcomes included intensive care unit length of stay, hospital length of stay, and adverse events. A sensitivity analysis was performed restricted to RCTs and quasi-RCTs, and a number of predefined subgroups were identified to explore heterogeneity. Measurements and Main Results:Ten studies (four RCTs, six observational studies, 1,248 patients) were included. There was no significant difference in hospital mortality with ECLS as compared with mechanical ventilation (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.79-1.33; I 2 = 77%). When restricted to venovenous ECLS studies of randomized trials and quasi-randomized trials (three studies; 504 patients), there was a decrease in mortality with ECLS compared with mechanical ventilation (RR, 0.64; 95% CI, 0.51-0.79; I 2 = 15%). There were insufficient study-level data to evaluate most secondary outcomes. Bleeding was significantly greater in the ECLS group (RR, 11.44; 95% CI, 3.11-42.06; I 2 = 0%). In the H1N1 subgroup (three studies; 364 patients), ECLS was associated with significantly lower hospital mortality (RR, 0.62; 95% CI, 0.45-0.8; I 2 = 25%).Conclusions: ECLS was not associated with a mortality benefit in patients with acute respiratory failure. However, a significant mortality benefit was seen when restricted to higher-quality studies of venovenous ECLS. Patients with H1N1-acute respiratory distress syndrome represent a subgroup that may benefit from ECLS. Future studies are needed to confirm the efficacy of ECLS as well as the optimal configuration, indications, and timing for adult patients with respiratory failure.

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“…Among these, age9, 18, 21, 22, 23, 24 and SOFA score21, 22, 23, 24 were found to be particularly closely associated with hospital mortality and were independent prognostic factors in ARDS patients receiving ECMO support. Roch et al 22.…”

Section: Discussionmentioning

confidence: 96%

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Takauji

Hayakawa

Ono

et al. 2017

Acute Medicine & Surgery

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AimThis multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.MethodsThe data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno‐venous ECMO support. The main outcome was in‐hospital all‐cause mortality.ResultsOf 3195 patients with severe sepsis, 570 had severe respiratory failure. Forty patients in the ECMO group were matched with 150 patients in the control group. A survival time analysis revealed no difference in the in‐hospital survival (hazard ratio, 0.854; 95% confidence interval, 0.531–1.373; P = 0.515). Two‐hundred and eighty‐five patients had severe respiratory failure induced by lung infection. Twenty‐five ECMO group patients were matched with 89 patients in the control group. In the ECMO group, the survival time was longer than in the control group (hazard ratio, 0.498; 95% confidence interval, 0.279–0.889; P = 0.018). The number of renal replacement therapy‐ and vasopressor‐free days improved. The ECMO group received more red blood cells transfused than the control group, but there was no significant difference in the rate of severe bleeding complications between the groups.ConclusionsThere was no difference in the in‐hospital survival between the ECMO group and control group among overall septic patients with severe respiratory failure. However, in sepsis patients with severe respiratory failure induced by lung infection, ECMO support may improve their survival time.

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Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange

Abstract: ECMO treatment does not predict mortality in patients with most severe ARDS.

Cited by 84 publications

References 17 publications

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

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