Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure

TLDR

A multicenter prospective randomized trial evaluated prolonged extracorporeal membrane oxygenation (ECMO) versus conventional mechanical ventilation, with 90 adults meeting arterial hypoxemia criteria randomized to either standard ventilation (48) or ventilation plus partial venoarterial bypass (42). Only four patients in each group survived; most patients had bacterial or viral pneumonia, and all nine with pulmonary embolism and six with posttraumatic ARF died, with deaths mainly due to progressive loss of transpulmonary gas exchange and decreased compliance from diffuse pulmonary inflammation, necrosis, and fibrosis, leading the authors to conclude that ECMO supports gas exchange but does not improve long‑term survival in severe ARF. 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)