Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching.

Yu-Jr Lin,Li-Chung Chiu,Hsin-Hsien Li,Shaw-Woei Leu,Feng-Chun Tsai,Chung-Chi Huang,Chih-Hao Chang,Li-Pang Chuang,Shih-Wei Lin,Chee-Jen Chang,Kuo-Chin Kao,Chen-Yiu Hung,Han-Chung Hu,Huang-Pin Wu

doi:10.3390/membranes11060393

Abstract

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

Highlights

Acute respiratory distress syndrome (ARDS) is a lethal form of acute respiratory failure with hypoxemia
The Extracorporeal membrane oxygenation (ECMO) group was drawn from a pool of 158 patients with severe acute respiratory distress syndrome (ARDS) who received ECMO, and the overall all-cause in-hospital mortality rate was 55.1%
The non-ECMO study group was drawn from 122 patients who were reclassified as severe ARDS at 48 h after ARDS onset, and the overall all-cause in-hospital mortality rate was 79.5%

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a lethal form of acute respiratory failure with hypoxemia. The mortality rate among patients with the severe form of ARDS exceeds. A lung-protective ventilation strategy with lower tidal volumes and lower airway pressures remained the mainstay of management for ARDS, and early application of prolonged prone position was suggested for severe ARDS to improve oxygenation and improve the likelihood of survival [3,4]. In the event that lung-protective ventilation is ineffective, extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy to treat refractory hypoxemia and alleviate ventilator-induced lung injury [5,6,7]. The actual survival benefits of ECMO in cases of severe ARDS have not been thoroughly investigated

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Discussion

Conclusion