title: Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure: the Massachusetts General Hospital experience from 1990 to 2008.
abstract: OBJECTIVE
  To determine the efficacy of extracorporeal membrane oxygenation (ECMO) for nonneonatal acute respiratory failure.
  
  
  METHODS
  Single-institution, retrospective medical record review from February 1990 to March 2008.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Eighty-one nonneonatal patients (mean age, 23 years; age range, 2 months to 61 years) with acute respiratory failure who had failed maximal ventilator support received ECMO therapy between 1990 and 2008. Patients were grouped into 6 categories based on diagnosis: sepsis (n = 8), bacterial or fungal pneumonia (n = 15), viral pneumonia (n = 9), trauma or burn (n = 10), immunocompromise (n = 15), and other (n = 24). Main Outcome Measure Survival to hospital discharge.
  
  
  RESULTS
  Overall survival was 53%. Survival was highest in patients with viral pneumonia (78%), followed by bacterial pneumonia (53%), sepsis syndrome (44%), and immunocompromise (40%). Patients treated following trauma or burns had the lowest survival (33%). The average age was 19 years for survivors as compared with 27 years for nonsurvivors. Survival was lower in patients with multiple organ failure as compared with those with single organ failure (33% vs 60%, respectively), in patients who experienced mechanical ventilation for longer than 10 days prior to the initiation of ECMO as compared with those who received ventilatory support for less than 10 days prior to the initiation of ECMO (31% vs 57%, respectively), and in patients requiring more than 400 hours of ECMO support as compared with those requiring less than 400 hours of ECMO support (42% vs 55%, respectively).
  
  
  CONCLUSIONS
  Therapy with ECMO may provide a survival benefit in carefully selected patients with nonneonatal acute respiratory failure who have failed maximal ventilator support. Nonneonatal survival with ECMO therapy is strongly dependent on diagnosis, with the highest survival seen in those with viral or bacterial pneumonia. Older age, multiple organ failure, prolonged ventilation prior to ECMO initiation, and long ECMO runs are associated with decreased survival.
authors.affiliation: Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Deepika
authors.initials: D
authors.lastname: Nehra
authors.forename: Allan M
authors.initials: AM
authors.lastname: Goldstein
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Doody
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Peter T
authors.initials: PT
authors.lastname: Masiakos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome