Abstract
Objective: To assess the feasibility of extracorporeal membrane oxygenation (ECMO) or life support (ECLS) as last resort life support therapy in patients with acute pancreatitis and subsequent secondary acute respiratory distress syndrome (ARDS). Methods: Retrospective analysis from January 2013, to April 2020, of ECMO patients with pancreatitis-induced ARDS at a German University Hospital. Demographics, hospital and ICU length of stay, duration of ECMO therapy, days on mechanical ventilation, fluid balance, need for decompressive laparotomy, amount of blood products, prognostic scores (CCI (Charlson Comorbidity Index), SOFA (Sequential Organ Failure Assessment), RESP(Respiratory ECMO Survival Prediction), SAVE (Survival after Veno-Arterial ECMO)), and the total known length of survival were assessed. Results: A total of n = 495 patients underwent ECMO. Eight patients with acute pancreatitis received ECLS (seven veno-venous, one veno-arterial). Five (71%) required decompressive laparotomy as salvage therapy due to abdominal hypertension. Two patients with acute pancreatitis (25%) survived to hospital discharge. The overall median length of survival was 22 days. Survivors required less fluid in the first 72 h of ECMO support and showed lower values for all prognostic scores. Conclusion: ECLS can be performed as a rescue therapy in patients with pancreatitis and secondary ARDS, but nevertheless mortality remains still high. Thus, this last-resort therapy may be best suited for patients with fewer pre-existing comorbidities and no other organ failure.
Highlights
Acute pancreatitis remains a life-threatening disease with an increasing incidence in Western countries [1,2]
About 20% of the patients with acute pancreatitis suffer from a severe course of the disease. [4,14]
Acute pancreatitisassociated mortality is further increased if complications such as secondary acute respiratory distress syndrome (ARDS) develop [15,17]
Summary
Acute pancreatitis remains a life-threatening disease with an increasing incidence in Western countries [1,2]. It represents one of the most common diagnoses for hospital admission in patients with a gastrointestinal disorder [3]. The incidence of acute pancreatitis for both outpatient contacts and hospital admissions has increased [6,7]. Frequent pathologies of acute pancreatitis are migrating gallstones, that cause transient obstruction of the pancreatic duct [8], and intense alcohol abuse [9,10]. Patients who develop persistent organ failure have significantly increased mortality with reported rates of 36–50% [15,16,17]
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