Spontaneous breathing in patients with severe acute respiratory distress syndrome receiving prolonged extracorporeal membrane oxygenation

Jingen Xia,Guohui Fan,Xu Huang,Qingyuan Zhan,Sichao Gu,Lijuan Wu,Min Li,Li Yi,Donglin Liu

doi:10.1186/s12890-019-1016-2

Abstract

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) in awake, spontaneously breathing and non-intubated patients (awake ECMO) may be a novel therapeutic strategy for severe acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to assess the feasibility and safety of awake ECMO in severe ARDS patients receiving prolonged ECMO (> 14 days).MethodsWe describe our experience with 12 consecutive severe ARDS patients (age, 39.1 ± 16.4 years) supported with awake ECMO to wait for native lung recovery during prolonged ECMO treatment from July 2013 to January 2018. Outcomes are reported including the hospital mortality, ECMO-related complications and physiological data on weaning from invasive ventilation.ResultsThe patients received median 26.0 (15.5, 64.8) days of total ECMO duration in the cohort. The longest ECMO support duration was 121 days. Awake ECMO and extubation was implemented after median 10.2(5.0, 42.9) days of ECMO. Awake ECMO was not associated with increased morbidity. The total invasive ventilation duration, lengths of stay in the ICU and hospital in the cohort were 14.0(12.0, 37.3) days, 33.0(22.3, 56.5) days and 46.5(27.3, 84.8) days, respectively. The hospital mortality rate was 33.3% (4/12) in the cohort. Survivors had more stable respiratory rate and heart rate after extubation when compared to the non-survivors.ConclusionsWith carefully selected patients, awake ECMO is a feasible and safe strategy for severe pulmonary ARDS patients receiving prolonged ECMO support to wait for native lung recovery.

Highlights

The use of extracorporeal membrane oxygenation (ECMO) in awake, spontaneously breathing and non-intubated patients may be a novel therapeutic strategy for severe acute respiratory distress syndrome (ARDS) patients
We first present our experience with 12 ARDS patients treated with awake ECMO to wait for native lung recovery during prolonged ECMO treatment
We retrospectively reviewed the prospectively constituted ECMO database of our 26-bed medical ICU to identify all severe ARDS patients supported with ECMO between July 2013 and January 2018

Summary

Introduction

The use of extracorporeal membrane oxygenation (ECMO) in awake, spontaneously breathing and non-intubated patients (awake ECMO) may be a novel therapeutic strategy for severe acute respiratory distress syndrome (ARDS) patients. Extracorporeal membrane oxygenation (ECMO) is often used as a rescue therapy for patients with severe acute respiratory distress syndrome (ARDS) refractory to conventional invasive mechanical ventilation (IMV) [1]. Awake ECMO may be a potential novel strategy to replace invasive mechanical ventilation for severe ARDS patients without multiple organ dysfunction [8, 16]. The median duration of ECMO to treat acute respiratory failure is typically 7 to 10 days, some patients may need longer time to wait for the recovery of native lung function [22, 23]. We first present our experience with 12 ARDS patients treated with awake ECMO to wait for native lung recovery during prolonged ECMO treatment

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