Extracorporeal membrane oxygenation for adult respiratory failure.
OBJECTIVE
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.


METHODS
Retrospective chart review.


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


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


METHODS
None.


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.
Peek
G J
GJ
Heartlink ECMO Centre, Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK.
Moore
H M
HM
Moore
N
N
Sosnowski
A W
AW
Firmin
R K
RK
D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D004298:Dopamine / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D005544:Forecasting; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D008875:Middle Aged; D016017:Odds Ratio; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood; D010351:Patient Discharge; D010366:Peak Expiratory Flow Rate; D011175:Positive-Pressure Respiration; D011312:Pressure; D012123:Pulmonary Ventilation / Q000502:physiology; D012119:Respiration; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
D002316:Cardiotonic Agents; D010100:Oxygen; D004298:Dopamine