Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation.

Sacha Rozencwajg,David Pilcher,Matthieu Schmidt,Alain Combes

doi:10.1186/s13054-016-1568-y

Abstract

Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) has known a growing interest over the last decades with promising results during the 2009 A(H1N1) influenza epidemic. Targeting populations that can most benefit from this therapy is now of major importance.Survival has steadily improved for a decade, reaching up to 65% at hospital discharge in the most recent cohorts. However, ECMO is still marred by frequent and significant complications such as bleeding and nosocomial infections. In addition, physiological and psychological symptoms are commonly described in long-term follow-up of ECMO-treated ARDS survivors. Because this therapy is costly and exposes patients to significant complications, seven prediction models have been developed recently to help clinicians identify patients most likely to survive once ECMO has been initiated and to facilitate appropriate comparison of risk-adjusted outcomes between centres and over time. Higher age, immunocompromised status, associated extra-pulmonary organ dysfunction, low respiratory compliance and non-influenzae diagnosis seem to be the main determinants of poorer outcome.

Highlights

Extracorporeal membrane oxygenation (ECMO) is considered a therapeutic option for patients with severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia or unable to tolerate volume-limited strategies [1, 2]
Use of ECMO has been growing exponentially in the last decade [3], encouraged by promising results from the multi-centred randomized controlled trial CESAR [4] and benefits described during the influenza A(H1N1) pandemic
Most of the severe ARDS patients are either referred to ECMO referral centres [4, 9] or cannulated in a distant hospital by a mobile ECMO team [4, 10, 11]. Because this therapy is costly and exposes patients to significant complications, a number of prediction models have been developed recently to help clinicians identify patients most likely to survive once ECMO has been initiated and to facilitate appropriate comparison of risk-adjusted outcomes between centres and over time

Summary

Background

Extracorporeal membrane oxygenation (ECMO) is considered a therapeutic option for patients with severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia or unable to tolerate volume-limited strategies [1, 2]. ARDS acute respiratory distress syndrome, ECMO extracorporeal membrane oxygenation, HAD hospital anxiety and depression, HRQoL health-related quality of life, IES Impact of Event Scale, PFT pulmonary function tests, PTSD post-traumatic stress disorder, SF-36 Medical Outcome Short-Form, SGRQ St George’s Respiratory Questionnaire. Further data are needed to investigate the causes of haemolysis on ECMO and to elucidate its influence on morbidity and mortality Objectives of these scores Because of the significant numbers of ECMO-related complications, the high rates of long-term physical and psychological impairment, and the human and financial cost, identifying specific populations who could benefit most from this therapy is crucial.

Minute ventilation

Findings

Conclusion