Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study
10.1097/CM9.0000000000000424
- Author:
Song-Qiao LIU
1
;
Ying-Zi HUANG
1
;
Chun PAN
1
;
Lan-Qi GUO
1
;
Xiao-Ting WANG
2
;
Wen-Kui YU
3
;
Yun-Fu WU
4
;
Jie YAN
5
;
Hong-Sheng ZHAO
6
;
Ling LIU
1
;
Feng-Mei GUO
1
;
Jing-Yuan XU
1
;
Yi YANG
1
;
Hai-Bo QIU
1
Author Information
1. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
2. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100010, China
3. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
4. Department of Critical Care Medicine, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu 215001, China
5. Department of Critical Care Medicine, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, Jiangsu 214023, China
6. Department of Critical Care Medicine, Hospital of Nantong University, Nantong, Jiangsu 226001, China
- Publication Type:Journal Article
- Keywords:
Acute respiratory distress syndrome;
Extra-corporeal membrane oxygenation;
Mortality;
Multi-center;
Mechanical ventilation
- From:
Chinese Medical Journal
2019;132(18):2192-2198
- CountryChina
- Language:English
-
Abstract:
Background:Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.
Methods:We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.
Results:Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001–1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264–8.609; P = 0.034).
Conclusions:This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.
