Extracorporeal membrane oxygenation for acute respiratory distress syndrome: a study of 11 cases

Abstract

To evaluate the value of extracorporeal membrane oxygenation (ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS). Twenty-five adult patients with severe ARDS admitted to Intensive Care Unit of Wuxi People's Hospital from January 2008 to June 2011 were retrospectively studied. All the cases met the ECMO criteria. Patients were divided into ECMO group and non-ECMO group according to whether they were treated with ECMO or not. ECMO group was further divided into ECMO survivor group and ECMO non-survivor group according to the situation on the 30(th) day after ECMO treatment. Clinical features and prognosis were compared between groups. The statistics software of SPSS 13.0 was used for data analysis. Of the 25 patients, 11 were treated with ECMO. There were 7 males and 4 females, aged from 21 to 61 years, with a mean age of (42 ± 12) years. Mean time of mechanical ventilation before ECMO therapy was (12 ± 8) h, with PaO2/FiO2 of (52 ± 19) mm Hg (1 mm Hg = 0.133 kPa) and PaCO2 (84 ± 11) mm Hg. Six patients treated with ECMO survived. The survival rate between the ECMO group and non-ECMO group was not significantly different (54.5%, 35.7%, χ(2) = 2.232, P > 0.05). Duration of ECMO therapy was (10.4 ± 3.4) d in survivors and (6.2 ± 2.4) d in non-survivors. Early improvement of PaO2 to FiO2 ratio and decrease of PaCO2 were seen in both ECMO survivor group and non-survivor group (t = 2.568 - 22.490, all P < 0.05). In survivor group, serum lactate levels and norepinephrin doses decreased significantly (t = 4.679 - 23.397, all P < 0.05), while the serum lactate levels and norepinephrin doses increased in non-survivor group (t = 4.325 - 29.729, all P < 0.05). Available data and our experience suggest that ECMO may be an effective salvage treatment for severe ARDS and should be used as early as possible for ARDS patients responding poorly to conventional mechanical ventilation support.