title: Mechanical Ventilation in Patients with the Acute Respiratory Distress Syndrome and Treated with Extracorporeal Membrane Oxygenation: Impact on Hospital and 30 Day Postdischarge Survival.
abstract: Mechanical ventilation support for acute respiratory distress syndrome (ARDS) patients involves the use of low tidal volumes and positive end-expiratory pressure. Nevertheless, the optimal ventilator strategy for ARDS patients undergoing extracorporeal membrane oxygenation (ECMO) therapy remains unknown. A retrospective analysis of a consecutive series of adult ARDS patients treated with V-V ECMO from October 2012 to May 2015 was performed. Mechanical ventilation data, as well as demographic and clinical data, were collected. We assessed the association between ventilator data and outcomes of interest. The primary outcome was hospital survival. Secondary outcome was 30 day survival posthospital discharge. Sixty-four ARDS patients were treated with ECMO. Univariate analysis showed that plateau pressure was independently associated with hospital survival. Tidal volume, positive end-expiratory pressure (PEEP), and plateau were independently associated with 30 day survival. Multivariate analysis, after controlling for covariates, revealed that a 1 unit increase in plateau pressure was associated with a 21% decrease in the odds of hospital survival (95% confidence interval [CI] = 6.39-33.42%, p = 0.007). In regards to 30 day survival postdischarge, a 1 unit increase in plateau pressure was associated with a 14.4% decrease in the odds of achieving the aforementioned outcome (95% CI = 1.75-25.4%, p = 0.027). Also, a 1 unit increase in PEEP was associated with a 36.2% decrease in the odds of 30 day survival (95% CI = 10.8-54.4%, p = 0.009). Among ARDS patients undergoing ECMO therapy, only plateau pressure is associated with hospital survival. Plateau pressure and PEEP are both associated with 30 day survival posthospital discharge.
authors.affiliation: From the *Division of Pulmonary and Critical Care Medicine, †Respiratory Care Department, ‡Department of Cardiovascular ICU, Baylor University Medical Center, Dallas, Texas; §Division of Clinical Research and Evaluative Science, Creighton University, Omaha, Nebraska; and ¶Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Modrykamien
authors.forename: Omar O
authors.initials: OO
authors.lastname: Hernandez
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Im
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Walters
authors.forename: Caleb L
authors.initials: CL
authors.lastname: Schrader
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Smith
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013990:Tidal Volume