Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure

Abstract

Background A group of patients with severe acute respiratory distress syndrome ( ARDS ) is resistant to advanced respiratory therapy. In these patients, extracorporeal membrane oxygenation ( ECMO ) can be used as a rescue therapy. This study presents 14 years of experience from a S candinavian ECMO centre. The aim of the study is to present outcome results and to investigate whether or not simplified acute physiology score II ( SAPS‐II ), sequential organ failure assessment ( SOFA ) and/or M urray scores can be used to predict patients' outcome. Methods I n a prospective observational study, we collected data from ECMO patients from J anuary 1997 to M arch 2011. The treatment was based mainly on venous‐venous ECMO and centrifugal pumps. Patients were retrieved from D enmark plus a number from S weden and N orway. The inclusion criteria were the classical criteria until N ovember 2009 ( n = 100), after which the new E xtracorporeal L ife S upport O rganisation criteria ( n = 24) were used. Results One hundred and twenty‐four patients were enrolled with median age 45 (range 16–67) years. The median M urray score was 3.7 (2.5–4.0). One hundred and six (85%) of the patients were retrieved from referring hospitals on ECMO . The median duration of the ECMO runs was 215 (1–578) h. Ninety‐seven (78%) of the patients could be weaned from ECMO . A total of 88 (71%) were discharged alive to the referring hospitals. High SAPS‐II , SOFA and M urray scores were associated with a high mortality. Conclusion Patients with severe ARDS have a favourable outcome when treated with ECMO and when an ECMO retrieval team establishes the ECMO treatment at the referring hospital. SAPS‐II , SOFA and M urray scores predicted the outcome.