Adult respiratory distress syndrome (ARDS) has been the major cause of mortality in
burn injury. The authors reported the experience of using
extracorporeal membrane oxygenation (ECMO) to treat adult
burn patient with ARDS. Three patients with
burn or
electric injury, around 48.9% of body surface area over second-degree
burns, developed ARDS after
resuscitation. All had positive blood culture and depended on a
ventilator more than 5 days before ECMO. Venovenous (VV) ECMO was started at the beginning of severe
respiratory failure with an
oxygen index of 61.6 +/- 15.5 cm H2O/mm Hg (> or =40 cm H2O/mm Hg), partial arterial
oxygen tension to inspired
oxygen fraction (Pa(O2)/Fi(O2)) of 46.1 +/- 7.0 mm Hg (< or =200 mm Hg),
positive end expiratory pressure (PEEP) of 15.7 +/- 1.6 cm H2O (> or =10 cm H2O), alveolar-arterial difference in
oxygen concentration (A-a D(O2)) of 618.9 +/- 19.3 mm Hg (> or =300 mm Hg), and lung compliance of 17.3 +/- 4.6 ml/cm H2O (< or =30 ml/cm H2O). The VV type had to be converted to the newly designed veno-venoarterial (V-VA) ECMO due to the myocardial dysfunction. Two of three patients survived. The duration of ECMO was 160.2 +/- 51.1 h. Two patients received
debridement of escar during ECMO support and
desmopressin infusion, and no increased
bleeding or coagulopathy was found. The respiratory parameters were significantly improved after ECMO, especially in the survivors. ECMO is also suitable for ARDS in adult
burn injury.