title: Awake extracorporeal membrane oxygenation in patients with severe postoperative acute respiratory distress syndrome.
abstract: BACKGROUND
  A clinical trial of extracorporeal membrane oxygenation (ECMO) as an alternative ventilator tool is being performed as a new indication for ECMO. The purpose of this study was to evaluate the feasibility of awake ECMO to increase the success rate of weaning patients from ECMO and ventilator care during treatment of postoperative severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We retrospectively analyzed the clinical reports of 10 patients who underwent awake ECMO due to postoperative ARDS between August 2012 and May 2015. We analyzed patient history, the partial arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, and patient outcome.
  
  
  RESULTS
  Seven patients (70%) were weaned from ECMO without difficulty; one patient failed to maintain awake ECMO, was re-intubated after 2 days of awake ECMO, and was re-tried on awake ECMO after 4 days of ventilator care. We weaned that patient from ECMO 2 days later. We weaned a total of eight patients (80%) from awake ECMO. The ECMO duration of surviving patients was 9.13±2.2 days (range, 6-12 days), and mean ventilator use duration was 6.8±4.7 days (range, 2-16 days). Two cases failed awake ECMO and died due to disease aggravation.
  
  
  CONCLUSIONS
  Awake ECMO was a useful weaning strategy after severe postoperative ARDS, as it avoids long-duration use of mechanical ventilation. Additionally, it is possible for patients to breathe spontaneously, which might prevents respiratory muscle dystrophy.
authors.affiliation: 1 Department of Internal medicine, Medical Research Institute of Pusan National University, 2 Department of Thoracic and Cardiovascular Surgery, the Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea.
authors.forename: Hye Ju
authors.initials: HJ
authors.lastname: Yeo
authors.affiliation: 1 Department of Internal medicine, Medical Research Institute of Pusan National University, 2 Department of Thoracic and Cardiovascular Surgery, the Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
authors.affiliation: 1 Department of Internal medicine, Medical Research Institute of Pusan National University, 2 Department of Thoracic and Cardiovascular Surgery, the Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea.
authors.forename: Dohyung
authors.initials: D
authors.lastname: Kim
keywords: Extracorporeal membrane oxygenation (ECMO); acute respiratory distress syndrome (ARDS); ventilator weaning