Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center
Lei Huang, Tong Li, Lei Xu, Xiao-min Hu, Da-wei Duan, Zhi-bo Li, Xin-jing Gao, Jun Li, Peng Wu, Ying-Wu Liu
(Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China (mainland))
Med Sci Monit 2017; 23:741-750
No definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center’s experience with ECMO and determine predictors of outcome from our Chinese center.
MATERIAL AND METHODS: We retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated.
RESULTS: Hemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=–0.463, p=0.03), acute kidney injury (r=–0.574, p=0.005), membrane oxygenator replacement (r=–0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000).
CONCLUSIONS: ECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter-hospital transport can be administered safely.
Keywords: Critical Illness, Extracorporeal Membrane Oxygenation, Respiration, Artificial, Respiratory Distress Syndrome, Adult