title: Extracorporeal membrane oxygenation (ECMO) in adults with acute respiratory distress syndrome (ARDS): A 6-year experience and case-control study.
abstract: To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults.
  
  
  
  a) Descriptive study of 15 cases treated since the program approval from 2010 to 2016. b) Case-control study matching the 15 ECMO cases with the 52 severe ARDS treated between 2005 and 2011 in which alternative rescue treatments (prone ventilation, tracheal gas insufflation (TGI) and/or the administration of inhaled nitric oxide (iNO)) were used.
  
  
  
  ECMO experience: Mortality 47% (7/15). Four patients died due to complications directly related to ECMO therapy. ICU stay 46.6 ± 45 days (range 4-138). Hospital stay 72.4 ± 98 days (range 4-320). Case-control: The mortality in the control group was 77% (44/52). The ECMO group practically doubled the mean days of ICU and hospital stay (p < 0.05). The multivariate analysis demonstrated an OR of 0.13 (0.02-0.73) for mortality associated with ECMO treatment. The following were also independent predictors of mortality: age (OR 1.05, 95% CI 1-11), SOFA score (OR 1.34, 95% CI 1.04-1.7), and the need for renal replacement therapy (OR 1.3, 95% CI 1.04-1.7). Economic analysis: The hospital cost per patient in the ECMO group doubled compared to that of the control group (USD 77,099 vs USD 37,660). However, the cost per survivor was reduced by 4% (USD 144,560 vs USD 150,640, respectively).
  
  
  
  Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness.
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain. Electronic address: j.munoz@salud.madrid.org.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñoz
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Santa-Teresa
authors.affiliation: Hospital General Universitario "Puerta de Hierro", Spain.
authors.forename: María Jesus
authors.initials: MJ
authors.lastname: Tomey
authors.affiliation: CS "Ramón y Cajal", Alcorcón, Madrid, Spain.
authors.forename: Lourdes Carmen
authors.initials: LC
authors.lastname: Visedo
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Keough
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Juan Camilo
authors.initials: JC
authors.lastname: Barrios
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Sabell
authors.affiliation: ICU, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Morales
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ARDS; ECMO; Extracorporeal life support; Mechanical ventilation; Respiratory insufficiency