High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation.
OBJECTIVE
We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory distress syndrome (ARDS).


METHODS
Uncontrolled prospective trial.


METHODS
One university hospital intensive care department.


METHODS
122 patients with ARDS, consecutively admitted to the ICU.


METHODS
ARDS was treated according to a criteria-defined clinical algorithm. The algorithm distinguished two main treatment groups: The AT-sine-ECMO (advanced treatment without extracorporeal membrane oxygenation) groups (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) using heparin-coated systems.


RESULTS
The groups differed in both APACHE II (16 +/- 5 vs 18 +/- 5 points, p = 0.01) and Murray scores (3.2 +/- 0.3 vs 3.4 +/- 0.3 points, p = 0.0001), the duration of mechanical ventilation prior to admission (10 +/- 9 vs 13 +/- 9 days, p = 0.0151), and length of ICU stay in Berlin (31 +/- 17 vs 50 +/- 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 +/- 27 mm Hg in AT-sine-ECMO patients that improved to 165 +/- 107 mm Hg on ICU day 1, while ECMO patients showed an initial PaO2/FIO2 of 67 +/- 28 mm Hg and improvement to 160 +/- 102 mm Hg was not reached until ICU day 13. QS/QT was significantly higher in the ECMO-treated group and exceeded 50% during the first 14 ICU days. The overall survival rate in our 122 ARDS patients was 75%. Survival rates were 89% in the AT-sine ECMO group and 55% in the ECMO treatment group (p = 0.0000).


CONCLUSIONS
We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.
Lewandowski
K
K
Klinik für Anästhesiologie und operative Intensivmedizin, Medizinische Fakultät der Humboldt-Universität zu Berlin, Germany.
Rossaint
R
R
Pappert
D
D
Gerlach
H
H
Slama
K J
KJ
Weidemann
H
H
Frey
D J
DJ
Hoffmann
O
O
Keske
U
U
Falke
K J
KJ
D000328:Adult; D000465:Algorithms; D002423:Cause of Death; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012107:Research Design; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis