title: Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center.
abstract: BACKGROUND
  The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center.
  
  
  METHODS
  Patients with refractory hypoxic ARDS received ECMO until they recovered lung function or demonstrated futility. ECMO was initiated at the referring facility if necessary, and aggressive critical care was maintained throughout.
  
  
  RESULTS
  ARDS due to multiple etiologies was managed with ECMO in 36 adults. The pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 48.3 ± 2.2. Regional facilities referred 89% of these patients, and 69% required ECMO for transport. The mean duration of ECMO was 7.1 ± .9 days for survivors, and the mean post-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 281.2 ± 11. ECMO was successfully weaned in 67% of patients, and 60% survived to discharge.
  
  
  CONCLUSIONS
  ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.
authors.affiliation: Legacy Emanuel Medical Center, Portland, OR, USA. amichael@lhs.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Hill
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Brian P
authors.initials: BP
authors.lastname: Young
authors.forename: Bernie P
authors.initials: BP
authors.lastname: Sperley
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Shanks
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers / Q000458:organization & administration*; D014187:Transportation of Patients / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult