Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome After Pneumonectomy.
BACKGROUND
Postpneumonectomy acute respiratory distress syndrome (ppARDS) is a life-threatening condition with a disastrous prognosis. This study assessed the efficacy of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with unresponsive severe ppARDS.


METHODS
We retrospectively reviewed data of all patients treated with VV-ECMO for ppARDS from January 2009 to December 2015. We calculated the Sequential Organ Failure Assessment score before ECMO insertion and monitored the subsequent mechanical ventilation settings. The primary end point was hospital survival. The secondary end point was the ability to achieve a protective ventilatory strategy allowing lung recovery on ECMO.


RESULTS
VV-ECMO was indicated in 8 ppARDS patients for refractory hypoxemia (median partial pressure of arterial oxygen/fraction of inspired oxygen: 68 [range, 60 to 75] mm Hg). Median Sequential Organ Failure Assessment before ECMO was 15 (range, 12 to 17), predicting a mortality rate greater than 80%. Median duration of ECMO was 9.5 (range, 5 to 16) days. Tidal volumes and plateau pressures both decreased on ECMO (pre-ECMO tidal volume: 412 [range, 250 to 450 mL] vs ECMO tidal volume: 277 [range, 105 to 367 mL], p = 0.0156; pre-ECMO plateau pressure: 34 [range, 32 to 40] cm H2O vs ECMO plateau pressure: 24.5 [range, 23.3 to 27.3] cm H2O, p = 0.0195). ECMO could be weaned in 7 patients (87.5%). Hospital survival was 50%.


CONCLUSIONS
Hospital survival was better than predicted before ECMO insertion. In severe and refractory ppARDS, VV-ECMO allows lung recovery and therefore increased survival.
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Jeremie
J
Reeb
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Anne
A
Olland
Surgical Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Julien
J
Pottecher
Medical Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Xavier
X
Delabranche
Department of Biostatistics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Mickael
M
Schaeffer
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Stephane
S
Renaud
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Nicola
N
Santelmo
Division of Respirology and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Romain
R
Kessler
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Gilbert
G
Massard
Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Electronic address: pierre-emmanuel.falcoz@wanadoo.fr.
Pierre-Emmanuel
PE
Falcoz
D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011013:Pneumonectomy / Q000009:adverse effects*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies
D010100:Oxygen