Extracorporeal membrane oxygenation for acute respiratory distress syndrome: Is the configuration mode an important predictor for the outcome?

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly applied as rescue-therapy for patients with severe acute respiratory distress syndrome (ARDS). Here, we evaluate the effect of different configuration strategies (venovenous vs. venoarterial vs. veno-venoarterial) on the outcome. From 2006 to 2008, 30 patients received ECMO for severe ARDS. Patients were divided into three groups according to the configuration: veno-venous (vv; ns11), venoarterial (va; ns8) or veno-venoarterial (vva; ns11). Data were prospectively collected and endpoint was 30-day mortality. To identify independent risk factors, univariate analysis was performed for clinical parameters, such as age, body mass index, gender, configuration, low-pH, oxygenation index (pO2 yFiO2) and underlying disease. Thirty-day mortality was 53% (ns16) for all comers: 63% (ns7) died in the vv-group, 75% (ns6) in the va-group and 27% (ns3) in the vva-group. Although univariate analysis could not rule out a significant predictor for the outcome, there was a trend visible to decreased mortality in the vva-group when compared to vv- and va-groups (27% vs. 63% vs. 75%; Ps0.057). ECMO provides a survival benefit in patients when considering a predicted mortality rate of 80% in ARDS. The configuration mode appears to impact the outcome as the veno-venoarterial appears to further improve the survival in this subset of patients. © 2011 Published by European Association for Cardio-Thoracic Surgery.