Chest
Volume 112, Issue 3, September 1997, Pages 759-764
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Clinical Investigations in Critical Care
Extracorporeal Membrane Oxygenation for Adult Respiratory Failure

https://doi.org/10.1378/chest.112.3.759Get rights and content

Objectives

To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation.

Design

Retrospective chart review.

Setting

Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center.

Patients

Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995.

Interventions

None.

Measurements and results

Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO2 to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressure, 39.6 (7.4) cm H2O; end-expiratory pressure, 10 (3.3) cm H2O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p=0.036 and p=0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p=0.036).

Conclusions

Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.

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)

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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.

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