Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults prognostic factors for outcomes

Abstract

Despite a therapeutic option for severe acute respiratory distress syndrome (ARDS), the survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) is still controversial in adults. This study was aimed at investigating the prognostic factors for ECMO-treated ARDS in adult patients. From 2012 to 2015, 49 patients (median age: 57 years) received VVECMO in our institution and were included in this retrospective study. The indication of VV-ECMO was a severe hypoxemia (PaO2/FiO2 ratio <70 mmHg) under mechanical ventilation (MV) with a peak inspiratory pressure (PIP) >35cmH2O and a FiO2 >0.8. To decrease the impact of pulmonary injuries associated with the high-pressure ventilation, the settings of MV on VV-ECMO were downgraded accorDing to our protocol. Outcomes of this study were death on VV-ECMO and death in hospital. Important demographic and clinical data during the treatment were collected for outcome analyses. All patients experienced significant improvements in arterial oxygenation onVV-ECMO.Twenty-four hours after initiation ofVV-ECMO, the median PaO2/FiO2 ratio increased from 58 to 172mmHg (P<0.001) and the median SaO2 increased from 86% to 97% (P<0.001). In the meantime, theMVsettings were also effectively downgraded. The median PIP decreased from 35 to 29cmH2O (P<0.001) and the median tidal volume decreased from 7 to 5 ml/kg/min (P<0.001). Twelve patients died during the treatment of VV-ECMO and 21 patients died before hospital discharge. Among all of the pre-ECMOvariables, the pre-ECMOpulmonary dynamic compliance (PCdyn) <20mL/cmH2O was identified to be the prognostic factor of death on VV-ECMO (odds ratio [OR]: 6, 95% confidence interval [CI]: 1-35, P<0.03), and the pre-ECMO duration of MV >90 hours was the prognostic factor of death before hospital discharge (OR: 7, 95% CI: 1-29, P<0.01). VV-ECMO was a useful salvage therapy for severe ARDS in adults. However, the value of PCdyn and the duration of MV before intervention with VV-ECMO may significantly affect the patients' outcomes.