Outcomes of Long-Term Veno-Venous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

Abstract

Purpose Given substantial advances in veno-venous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described in the literature, the outcomes of patients requiring long-term support remain unclear. Methods and Materials Patients requiring ECMO for ARDS between January 2009 and November 2012 were retrospectively reviewed and analyzed separately for those requiring short-term and long-term ECMO support (≥3 weeks). Demographics, ECMO variables and outcomes of patient bridged to recovery or transplantation were assessed. Results 57 patients with ARDS were placed on ECMO during that time period with 11 patients requiring long-term ECMO support (59±51 days). Recovery was the goal in all patients. In the long-term support group, pre-ECMO mechanical ventilation was conventional PC or PRVC (N=4), APRV (N=5), or HFO (N=2). The mean pre-ECMO FiO2 was 0.93±0.13 with mean pH, PaO2, and PaCO2 of 7.3±0.1, 69±26 mmHg, 63±21 mmHg, respectively. Pre-ECMO Murray Scores were 3.7±0.4 and 3.82±0.29 (p=NS) in the long-term and short-term groups, respectively. 8 (73%) long-term support patients were successfully bridged to recovery and 1 patient was bridged to transplantation after a refractory course. 25 (52%) short-term support patients and 8 (73%) long-term support patients survived to 30-days or hospital discharge. In the long-term support group, 4 of the 8 surviving patients had mid-term follow-up available; with 100% surviving, returned to home, and with normal functional status at 1 year. Conclusions Previously, long-term ECMO support has not been thought to be associated with favorable outcomes. This study, however, may provide support for the efficacy of ECMO for patients even requiring support greater than 3 weeks as a bridge to recovery or transplantation.