title: Prolonged duration ECMO for ARDS: futility, native lung recovery, or transplantation?
abstract: Extracorporeal membrane oxygenation (ECMO) is recommended as a treatment modality for severe acute respiratory distress syndrome (PaO2/FiO2 ≤ 100 mm Hg with positive end-expiratory pressure ≥ 5 cm H2O) as defined by the Berlin definition. The reported usual duration of ECMO in these patients is 7-10 days. However, increasing reports of prolonged duration ECMO (>14 days) for respiratory failure document survival rates of 50-70% with native lung recovery, and ECMO bridge to lung transplantation has been performed at many centers. At present, there are no established national criteria for when to consider futility or lung transplantation in adult patients requiring ECMO for acute respiratory failure. We report a case of prolonged duration venovenous-ECMO (1,347 hours, 56.13 days), with native lung recovery and discuss treatment strategies to optimize native lung recovery in ECMO patients. The lung may have unexpected regenerative capacity with native lung recovery after prolonged mechanical support, similar to acute kidney injury and native renal recovery. We recommend redefining irreversible lung injury and futility in ECMO.
authors.affiliation: From the *Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan; †Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; ‡University of Michigan Health Systems, Ann Arbor, Michigan; §Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; ¶Division of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan; and ‖Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Rosenberg
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Haft
authors.forename: Robert
authors.initials: R
authors.lastname: Bartlett
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.forename: Steven K
authors.initials: SK
authors.lastname: Huang
authors.forename: William R
authors.initials: WR
authors.lastname: Lynch
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D018447:Medical Futility; D020127:Recovery of Function; D012128:Respiratory Distress Syndrome / Q000601:surgery*; D013995:Time