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Clinical Investigations in Critical CareExtracorporeal Membrane Oxygenation for Adult Respiratory Failure
Section snippets
Setting
Our adult, pediatric, and neonatal ECMO program is recognized by the Extracorporeal Life Support Organization and the European Extracorporeal Life Support Organization. The program operates in the cardiac and pediatric ICUs of a cardiothoracic surgical department. The program is staffed by cardiothoracic surgeons, anesthesiologists, pediatricians, perfusionists, and nurses with specific training in ECMO. Patients are referred from hospitals all around the United Kingdom at the discretion of
Results
A total of 50 patient records were examined. Of these 50 patients, 33 survived (66%). Not all patients had all data points available in their records, either by reason of omission or because a pulmonary artery catheter was not present; therefore, the number of observations on which each datum is based is expressed as n. Survival by diagnosis is given in Table 1, status at ECMO referral is listed in Table 2, advanced treatment before ECMO in Table 3, and blood product use in Table 4. Other
Discussion
This study suggests that ECMO results in significantly improved hospital survival for patients in severe respiratory failure when compared to those receiving conventional treatment (p=0.036, p=0.0006). Using historical controls in this way is not ideal, as a randomized controlled trial of conventional treatment vs ECMO would give a much clearer answer. The survival in the two published randomized trials of adult extracorporeal life support8, 9 is markedly worse than that seen in our patients,
Acknowledgments
Mr. R. Reeves (Department of Perfusion, Glenfield Hospital); Mr. N. Taub (Department of Epidemiology, University of Leicester); and Dr. S. Arsiwala (Department of Cardiothoracic Surgery, Glenfield Hospital).
References (20)
- et al.
A prospective study of acute hypoxic respiratory failure
Chest
(1986) - et al.
Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: an international, multicenter, prospective study
Chest
(1995) - et al.
Increased survival of ARDS patients with severe hypoxemia (ECMO criteria)
Chest
(1991) - et al.
Role of extracorporeal membrane oxygenation [letter]
Lancet
(1996) - et al.
Mortality from severe adult respiratory distress syndrome (ARDS) remains unchanged
Am Rev Respir Dis
(1992) - et al.
Beneficial effects of the ‘open lung approach’ with low distending pressures in acute respiratory distress syndrome: a prospective randomized study on mechanical ventilation
Am J Respir Crit Care Med
(1995) - et al.
Permissive hypercapnia in trauma patients
J Trauma
(1995) UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation
Lancet
(1996)- et al.
Extracorporeal membrane oxygenation in severe acute respiratory failure
JAMA
(1979) - et al.
Randomized clinical trial of pressure controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome
Am J Respir Crit Care Med
(1994)
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Heartlink ECMO Centre receives support from Heartlink Children's Charity. Dr. Peek is the holder of a British Heart Foundation, Junior Research Fellowship.