Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange.
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.
Beiderlinden
Martin
M
Universitätsklinikum Essen, Klinik für Anästhesiologie und Intensivmedizin, Hufelandstrasse 55, 45122 Essen, Germany. martin.beiderlinden@uni-essen.de
Eikermann
Matthias
M
Boes
Tanja
T
Breitfeld
Christa
C
Peters
Jürgen
J
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