Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database.
OBJECTIVE
To evaluate clinical and treatment factors for patients recorded in the Extracorporeal Life Support Organization (ELSO) registry and survival of adult extracorporeal membrane oxygenation (ECMO) respiratory failure patients.


METHODS
Retrospective case review of the ELSO registry from 1986-2006. Data were analyzed separately for the entire time period and the most recent years (2002-2006).


RESULTS
Of 1,473 patients, 50% survived to discharge. Median age was 34 years. Most patients (78%) were supported with venovenous ECMO. In a multi-variate logistic regression model, pre-ECMO factors including increasing age, decreased weight, days on mechanical ventilation before ECMO, arterial blood pH <or= 7.18, and Hispanic and Asian race compared to white race were associated with increased odds of death. For the most recent years (n = 600), age and PaCO(2) >or= 70 compared to PaCO(2) <or= 44 were also associated with increased odds of death. The two diagnostic categories acute respiratory failure and asthma compared to ARDS were associated with decreased odds of mortality as was venovenous compared to venoarterial mode. CPR and complications while on ECMO including circuit rupture, central nervous system infarction or hemorrhage, gastrointestinal or pulmonary hemorrhage, and arterial blood pH < 7.2 or >7.6 were associated with increased odds of death.


CONCLUSIONS
Survival among this cohort of adults with severe respiratory failure supported with ECMO was 50%. Advanced patient age, increased pre-ECMO ventilation duration, diagnosis category and complications while on ECMO were associated with mortality. Prospective studies are needed to evaluate the role of this complex support mode.
Brogan
Thomas V
TV
Division of Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. botcho@u.washington.edu
Thiagarajan
Ravi R
RR
Rycus
Peter T
PT
Bartlett
Robert H
RH
Bratton
Susan L
SL
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000401:mortality / Q000628:therapy; D012042:Registries; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate