Survival predictors in acute respiratory distress syndrome with extracorporeal membrane oxygenation.

Abstract

BACKGROUND:

Extracorporeal membrane oxygenation (ECMO) can be used as a salvage therapy, but the effectiveness is controversial. The aim of this study was to investigate the predictors of mortality and the influence of organ dysfunction scores in severe acute respiratory distress syndrome (ARDS) patients treated with ECMO.

METHODS:

The records of adult severe ARDS patients receiving ECMO support from May 2006 to December 2011 at Chang Gung Memorial Hospital were retrospectively analyzed.

RESULTS:

The records of 65 patients with severe ARDS who received venovenous ECMO were analyzed. The hospital survival rate was 47.7%. Survivors were younger than nonsurvivors (41.4 ± 15.4 versus 54.1 ± 16.9 years, respectively; p = 0.002) and had shorter duration of mechanical ventilation before ECMO (52.7 ± 51.1 versus 112.1 ± 101.0 hours, respectively; p = 0.01). Before ECMO, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction scores were significantly lower for survivors than for nonsurvivors. Mortality rate increased with rising predictive score. During 7 days of ECMO use, organ dysfunction scores were significantly lower for survivors than nonsurvivors.

CONCLUSIONS:

Severe ARDS patients who are younger, have shorter duration of mechanical ventilation, and lower organ dysfunction scores before ECMO initiation have more favorable survival outcome. Early application of ECMO, especially if predictive score is below 2, may improve survival. Organ dysfunction scores before and during ECMO support are correlated with survival.

• Authors: Li-Chung Chiu, Feng-Chun Tsai, Han-Chung Hu, Chih-Hao Chang, Chen-Yiu Hung, Chung-Shu Lee, Shih-Hong Li, Shih-Wei Lin, Li-Fu Li, Chung-Chi Huang, Ning-Hung Chen, Cheng-Ta Yang, Yung-Chang Chen, Kuo-Chin Kao
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 99 Issue 1 Pg. 243-50 (Jan 2015) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 25442984 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Extracorporeal Membrane Oxygenation
• Female
• Humans
• Male
• Middle Aged
• Prognosis
• Respiratory Distress Syndrome (mortality, therapy)
• Retrospective Studies
• Severity of Illness Index
• Survival Rate