Intravenous immunoglobulin fails to improve ARDS in patients undergoing ECMO therapy

Stefanie Prohaska,Helene A Haeberle,Gunnar Blumenstock,Albina Bashota,Andrea Schirner,Andreas Körner

doi:10.1186/s40560-018-0278-8

Abstract

BackgroundAcute respiratory distress syndrome (ARDS) is associated with high mortality rates. ARDS patients suffer from severe hypoxemia, and extracorporeal membrane oxygenation (ECMO) therapy may be necessary to ensure oxygenation. ARDS has various etiologies, including trauma, ischemia-reperfusion injury or infections of various origins, and the associated immunological responses may vary. To support the immunological response in this patient collective, we used intravenous IgM immunoglobulin therapy to enhance the likelihood of pulmonary recovery.MethodsARDS patients admitted to the intensive care unit (ICU) who were placed on ECMO and treated with (IVIG group; n = 29) or without (control group; n = 28) intravenous IgM-enriched immunoglobulins for 3 days in the initial stages of ARDS were analyzed retrospectively.ResultsThe baseline characteristics did not differ between the groups, although the IVIG group showed a significantly reduced oxygenation index compared to the control group. We found no differences in the length of ICU stay or ventilation parameters. We did not find a significant difference between the groups for the extent of inflammation or for overall survival.ConclusionWe conclude that administration of IgM-enriched immunoglobulins as an additional therapy did not have a beneficial effect in patients with severe ARDS requiring ECMO support.Trial registrationClinical Trials: NCT02961166; retrospectively registered.

Highlights

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates
The objective of this study was to investigate whether intravenous immunoglobulin administration could improve the clinical course of ARDS in patients treated with extracorporeal membrane oxygenation (ECMO)
Twenty-eight patients were treated with IgM-enriched immunoglobulins (IVIG) for 3 days according to the manufacturer’s instruction (IVIG group), and 29 patients did not receive Intravenous immunoglobulin (IVIG) therapy

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates. ARDS patients suffer from severe hypoxemia, and extracorporeal membrane oxygenation (ECMO) therapy may be necessary to ensure oxygenation. One approach to support critically ill patients is intravenous administration of IgM-enriched immunoglobulins since this could potentially decrease the severity of inflammation This treatment was omitted in recent sepsis guidelines due to a lack of supporting evidence in high-quality trials [8], several studies, including one meta-analysis, describe beneficial effects of immunoglobulins in acute pneumonia induced by drug-resistant bacterial infections [9,10,11]. Several case reports describe beneficial effects of antiviral therapy in combination with intravenous immunoglobulin therapy in immune-compromised patients [12,13,14] Based on these data, we treated patients with ARDS requiring ECMO therapy with IgM-enriched immunoglobulins immediately after intensive care unit (ICU) admission. Mortality, the duration of ECMO therapy, the incidence of renal replacement therapy, the duration of vasopressor and anti-infective therapy, length of stay in the ICU, and length of stay in the hospital were analyzed retrospectively in 57 ARDS patients requiring ECMO therapy

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