[The clinical analysis of extracorporeal membrane oxygenation for adult severe acute respiratory distress syndrome].Zhonghua Jie He He Hu Xi Za Zhi. 2016 Apr 12; 39(4):291-7.ZJ
To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS).
The clinical data of 58 adult patients with severe ARDS, which met the criteria for ECMO and treated in comprehensive intensive care unit of the Second Affiliated Hospital of Zhengzhou University from August 2012 to June 2015, were retrospectively collected and analyzed. The patients were divided into the ECMO group and the control group according to whether ECMO support was used. The ECMO group was further divided into the survival group and the non-survival group according to outcomes 3 months after the initiation of ECMO. The statistics software of SPSS 17.0 was used for data analysis.
Of the 58 patients, 28 were treated with VV-ECMO. There were 22 males and 6 females, aged from 34 to 61 years, with a mean age of (49±8) years. Mean time of mechanical ventilation before ECMO therapy was(71±25) h. The main factors(the lowest PaO2/FiO2 and pH, the highest PEEP, PaCO2 and serum lactate level, the grade of APACHEⅡ, Murray and SOFA) between the ECMO group and the control group were not significantly different(all P>0.05). There were no significant differences in the factors before therapy(all P>0.05), except pH, heart rate (HR) and mean arterial pressure (MAP) between the ECMO survival group and the ECMO non-survival group. Compared with the factors at the same time point in the control group, those of the ECMO group were significantly improved after ECMO running 2 hours and 1 day (all P<0.05). Most factors of the ECMO group were also significantly improved after ECMO running 2 days (all P<0.05) except MAP; the MAP of the ECMO non-survival group being lower than the control group (t=2.433, P=0.019). After ECMO running 3 days, most factors of the ECMO survival group were better than those of the control group (all P<0.05) except MAP, but most factors between the ECMO non-survival group and the control group were not significantly different (all P>0.05), while the serum lactate level was higher (t=-3.156, P=0.003) and the MAP lower (t=3.578, P=0.001). Eighteen patients were successfully weaned from ECMO, and 15 patients survived to 3 months without severe disability. The survival rate between the ECMO group and the control group was not significantly different(53.57% and 43.33%, χ(2)=0.608, P=0.436).
Our experience suggests that VV-ECMO may be an effective life support treatment for severe ARDS and should be used as early as possible when the ECMO criteria are met. Indexes such as age, time of mechanical ventilation before ECMO therapy, time between disease onset and ECMO therapy, HR, MAP, serum lactate level and serum procalcitonin level, may be the risk factors for prognosis.