Venovenous extracorporeal membrane oxygenation for ARDS: outcome analysis of a Croatian referral center for respiratory ECMO.
BACKGROUND
The use of venovenous extracorporeal membrane oxygenation (VV-ECMO) as a rescue therapy in severe acute respiratory distress syndrome (ARDS) has become well established; however, the affirmation of evidence on VV-ECMO application and the analysis of patient outcomes after VV-ECMO treatment for ARDS continues. The aim of the study is to identify variables that affected the outcome of patients treated with VV-ECMO for severe ARDS outside a major ECMO center.


METHODS
The study included adult patients with severe ARDS treated with ECMO at a tertiary care hospital in Zagreb, Croatia between October 2009 and July 2014. Patients were recruited from a prospective database.


RESULTS
The study enrolled 40 patients, 20 of whom had H1N1-induced ARDS. The hospital mortality was 38%. The difference in mortality and long-term outcome in H1N1-induced ARDS as compared to non-H1N1-induced ARDS was not significant. Variables associated with mortality included immunosuppression, shock at time of admission, acute renal failure, occurrence of heparin-induced thrombocytopenia antibodies, nosocomial sepsis and duration of ECMO.


CONCLUSIONS
The results of our study indicate that ECMO use in severe ARDS is feasible with low mortality and identify or assert the variables associated with adverse outcomes.
Department of Intensive Care Medicine and Neuroinfectology, University of Zagreb - School of Medicine, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia. mkutlesa@bfm.hr.
Marko
M
Kutleša
Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", 10000, Zagreb, Croatia.
Anđa
A
Novokmet
Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", 10000, Zagreb, Croatia.
Renata
R
Josipović Mraović
Department of Intensive Care Medicine and Neuroinfectology, University of Zagreb - School of Medicine, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia.
Bruno
B
Baršić
D000328:Adult; D017523:Croatia; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers
ARDS; Extracorporeal membrane oxygenation; Heparin-induced thrombocytopenia; Influenza