Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study

TLDR

Most patients had acute bacterial or viral pneumonia, a common cause of severe acute respiratory failure. The study aimed to evaluate prolonged ECMO as a therapy for severe ARF. Ninety adults with arterial hypoxemia were randomized to conventional mechanical ventilation or ventilation with partial venoarterial bypass. Only four patients in each group survived; ECMO did not improve long‑term survival, with most deaths—including all nine with pulmonary embolism and six with posttraumatic ARF—due to progressive loss of gas exchange and lung compliance. Published in JAMA 242:2193‑2196 (1979).

Abstract

Nine medical centers collaborated in a prospective randomized study to evaluate prolonged extracorporeal membrane oxygenation (ECMO) as a therapy for severe acute respiratory failure (ARF). Ninety adult patients were selected by common criteria of arterial hypoxemia and treated with either conventional mechanical ventilation (48 patients) or mechanical ventilation supplemented with partial venoarterial bypass (42 patients). Four patients in each group survived. The majority of patients suffered acute bacterial or viral pneumonia (57%). All nine patients with pulmonary embolism and six patients with posttraumatic acute respiratory failure died. The majority of patients died of progressive reduction of transpulmonary gas exchange and decreased compliance due to diffuse pulmonary inflammation, necrosis, and fibrosis. We conclude that ECMO can support respiratory gas exchange but did not increase the probability of long-term survival in patients with severe ARF. (<i>JAMA</i>242:2193-2196, 1979)