title: Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center.
abstract: OBJECTIVE
  Patients with severe acute respiratory distress syndrome (ARDS) are candidates for extracorporeal membrane oxygenation (ECMO) therapy. The evaluation of organ severity is difficult in patients considered for cannulation in a distant hospital. This study was designed to identify early factors associated with hospital mortality in ARDS patients treated with ECMO and retrieved from referring hospitals.
  
  
  METHODS
  Data from 85 consecutive ARDS patients equipped with ECMO by our mobile team and consequently admitted to our ICU were prospectively collected and analyzed.
  
  
  RESULTS
  The main ARDS etiologies were community-acquired bacterial pneumonia (35%), influenza pneumonia (23%) (with 12 patients having been treated during the first half of the study period), and nosocomial pneumonia (14%). The median (interquartile range) time between contact from the referring hospital and patient cannulation was 3 (1-4) h. ECMO was venovenous in 77 (91%) patients. No complications occurred during transport by our mobile unit. Forty-eight patients died at the hospital (56%). Based on a multivariate logistic regression, a score including age, SOFA score, and a diagnosis of influenza pneumonia was constructed. The probability of hospital mortality following ECMO initiation was 40% in the 0-2 score class (n = 58) and 93% in the 3-4 score class (n = 27). Patients with an influenza pneumonia diagnosis and a SOFA score before ECMO of less than 12 had a mortality rate of 22%.
  
  
  CONCLUSIONS
  Age, SOFA score, and a diagnosis of influenza may be used to accurately evaluate the risk of death in ARDS patients considered for retrieval under ECMO from distant hospitals.
authors.affiliation: URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 13005, Marseille, France, antoine.roch@ap-hm.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: Elodie
authors.initials: E
authors.lastname: Masson
authors.forename: Dominique
authors.initials: D
authors.lastname: Grisoli
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boucekine
authors.forename: Pierre
authors.initials: P
authors.lastname: Morera
authors.forename: Christophe
authors.initials: C
authors.lastname: Guervilly
authors.forename: Mélanie
authors.initials: M
authors.lastname: Adda
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dizier
authors.forename: Richard
authors.initials: R
authors.lastname: Toesca
authors.forename: Fréderic
authors.initials: F
authors.lastname: Collart
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000328:Adult; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007251:Influenza, Human / Q000150:complications* / Q000401:mortality / Q000628:therapy; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011014:Pneumonia / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis