title: Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange.
abstract: OBJECTIVE
  To evaluate the effect of extracorporeal gas exchange (ECMO) on mortality of patients referred with severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  Prospective observational study in a university hospital ICU.
  
  
  METHODS
  150 patients with severe ARDS.
  
  
  METHODS
  Multimodal treatment with and without ECMO.
  
  
  RESULTS
  We treated 118 patients (78.7%) conservatively and 32 patients with ECMO. Patients in the ECMO group presented with significantly more severe disease (lung injury score 3.8+/-0.3 vs. 3.3+/-0.4; SOFA score 52+/-14 vs. 43+/-12; and SAPS score 14+/-3.3 vs. 10+/-3.5). Mortality in ECMO-treated patients tended to be higher than that with conservative treatment (46.9% vs. 28.8%, p=0.059). Multivariate logistic regression analyses with backward selection excluded ECMO as predictor of mortality (p=0.79). Independent predictors of mortality were age (odds ratio 1.044, 95% confidence interval 1.014-1.075, p=0.004), mean pulmonary artery pressure (1.082, 1.026-1.141, p=0.036), sequential organ failure assessment score (1.148, 1.018-1.294, p=0.024), and days of mechanical ventilation prior to referral (1.064, 1.008-1.123, p=0.025).
  
  
  CONCLUSIONS
  ECMO treatment does not predict mortality in patients with most severe ARDS.
authors.affiliation: Universitätsklinikum Essen, Klinik für Anästhesiologie und Intensivmedizin, Hufelandstrasse 55, 45122 Essen, Germany. martin.beiderlinden@uni-essen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Beiderlinden
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
authors.forename: Tanja
authors.initials: T
authors.lastname: Boes
authors.forename: Christa
authors.initials: C
authors.lastname: Breitfeld
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome