title: Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study.
abstract: The purpose of the study is to compare outcomes in patients who had severe hypoxemic respiratory failure (Pao2/fraction of inspired oxygen <100) who received early veno-venous extracorporeal membrane oxygenation (ECMO) as an adjunct to mechanical ventilation, to those in patients who received conventional mechanical ventilation alone.
  
  
  
  This is a multicenter, retrospective unmatched and matched cohort study of patients admitted between April 2006 and December 2013. Generalized logistic mixed-effects models and Cox proportional hazards models were used to determine the association between treatment with ECMO that was started within 3 days of intensive care unit (ICU) admission and ICU and hospital mortality and length of stay, respectively.
  
  
  
  A total of 2440 patients who had severe hypoxemic respiratory failure due to various etiologies were included, 46 who received early veno-venous ECMO and 2394 unmatched and 398 matched controls who received conventional ventilation alone. Compared to matched controls, ECMO was associated with a lower odds of ICU (odds ratio [95% confidence interval], 0.30 [0.13-0.67]) and inhospital death (odds ratio 0.30 [0.14-0.67]). In addition, ECMO was associated with longer times to discharge from ICU and hospital (hazard ratio, 0.42 [0.37-0.47] and 0.53 [0.38-0.73], respectively).
  
  
  
  In this observational study, use of early ECMO compared to conventional mechanical ventilation alone in patients who had severe hypoxemic respiratory failure was associated with a lower risk of mortality and a longer length of stay.
authors.affiliation: Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada. Electronic address: hdkanji@gmail.com.
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Kanji
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: McCallum
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Griesdale
authors.affiliation: Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Reynolds
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Isac
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Heart Centre, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Sirounis
authors.affiliation: Royal Columbian Hospital, Vancouver BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Gunning
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Finlayson
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis; D001955:British Columbia; D015331:Cohort Studies; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute respiratory distress syndrome; Critical care; Extracorporeal membrane oxygenation; Respiratory failure