title: Survival predictors in acute respiratory distress syndrome with extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) can be used as a salvage therapy, but the effectiveness is controversial. The aim of this study was to investigate the predictors of mortality and the influence of organ dysfunction scores in severe acute respiratory distress syndrome (ARDS) patients treated with ECMO.
  
  
  METHODS
  The records of adult severe ARDS patients receiving ECMO support from May 2006 to December 2011 at Chang Gung Memorial Hospital were retrospectively analyzed.
  
  
  RESULTS
  The records of 65 patients with severe ARDS who received venovenous ECMO were analyzed. The hospital survival rate was 47.7%. Survivors were younger than nonsurvivors (41.4 ± 15.4 versus 54.1 ± 16.9 years, respectively; p = 0.002) and had shorter duration of mechanical ventilation before ECMO (52.7 ± 51.1 versus 112.1 ± 101.0 hours, respectively; p = 0.01). Before ECMO, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction scores were significantly lower for survivors than for nonsurvivors. Mortality rate increased with rising predictive score. During 7 days of ECMO use, organ dysfunction scores were significantly lower for survivors than nonsurvivors.
  
  
  CONCLUSIONS
  Severe ARDS patients who are younger, have shorter duration of mechanical ventilation, and lower organ dysfunction scores before ECMO initiation have more favorable survival outcome. Early application of ECMO, especially if predictive score is below 2, may improve survival. Organ dysfunction scores before and during ECMO support are correlated with survival.
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Li-Chung
authors.initials: LC
authors.lastname: Chiu
authors.affiliation: Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Hu
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chen-Yiu
authors.initials: CY
authors.lastname: Hung
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chung-Shu
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shih-Hong
authors.initials: SH
authors.lastname: Li
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Lin
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Li
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ning-Hung
authors.initials: NH
authors.lastname: Chen
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Yang
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: kck0502@cgmh.org.tw.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate