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Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation.
Respir Med Case Rep. 2018; 25:220-224.RM

Abstract

Introduction

Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO.

Methods

Between July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain. These patients were treated with ECMO as salvage respiratory therapy. Outcomes included clinical data, ventilatory and blood gas characteristics, survival, and complications.

Results

Fifteen patients (83.3%) were previously treated in prone position. The indication of VV-ECMO was established at an early stage after a mean (SD) of 3.8 (2.5) days on mechanical ventilation. The mean duration of ECMO was 10.4 days, and 16 patients (88.9%) required venous cannulation, mostly femoral-internal jugular. The mean length of ICU stay was 27 days and the mean hospital stay was 42.1 days. The ICU survival rate was 55.5% (n = 10) and the hospital survival rate was 50% (n = 9).

Conclusions

This clinical study in a small series of ICU patients treated with ECMO confirms the usefulness of this technique as a ventilatory support in patients with refractory hypoxemic respiratory failure. However, the indication of this procedure is also committed to an ethical reflection considering the possible futility of the measure on a case-by-case basis and associated complications.

Authors+Show Affiliations

Intensive Care Unit, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.Intensive Care Unit, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

30237974

Citation

Periche Pedra, Elisabet, et al. "Outcomes of Extracorporeal Membrane Oxygenation in Adult Patients With Hypoxemic Respiratory Failure Refractory to Mechanical Ventilation." Respiratory Medicine Case Reports, vol. 25, 2018, pp. 220-224.
Periche Pedra E, Koborzan MR, Sbraga F, et al. Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation. Respir Med Case Rep. 2018;25:220-224.
Periche Pedra, E., Koborzan, M. R., Sbraga, F., Blasco Lucas, A., & Toral Sepúlveda, D. (2018). Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation. Respiratory Medicine Case Reports, 25, 220-224. https://doi.org/10.1016/j.rmcr.2018.09.007
Periche Pedra E, et al. Outcomes of Extracorporeal Membrane Oxygenation in Adult Patients With Hypoxemic Respiratory Failure Refractory to Mechanical Ventilation. Respir Med Case Rep. 2018;25:220-224. PubMed PMID: 30237974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation. AU - Periche Pedra,Elisabet, AU - Koborzan,Melinda Rita, AU - Sbraga,Fabrizio, AU - Blasco Lucas,Arnau, AU - Toral Sepúlveda,David, Y1 - 2018/09/13/ PY - 2018/07/24/received PY - 2018/09/10/revised PY - 2018/09/11/accepted PY - 2018/9/22/entrez PY - 2018/9/22/pubmed PY - 2018/9/22/medline KW - Extracorporeal membrane oxygenation KW - Hypoxemia KW - Respiratory failure KW - salvage respiratory therapy SP - 220 EP - 224 JF - Respiratory medicine case reports JO - Respir Med Case Rep VL - 25 N2 - Introduction: Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO. Methods: Between July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain. These patients were treated with ECMO as salvage respiratory therapy. Outcomes included clinical data, ventilatory and blood gas characteristics, survival, and complications. Results: Fifteen patients (83.3%) were previously treated in prone position. The indication of VV-ECMO was established at an early stage after a mean (SD) of 3.8 (2.5) days on mechanical ventilation. The mean duration of ECMO was 10.4 days, and 16 patients (88.9%) required venous cannulation, mostly femoral-internal jugular. The mean length of ICU stay was 27 days and the mean hospital stay was 42.1 days. The ICU survival rate was 55.5% (n = 10) and the hospital survival rate was 50% (n = 9). Conclusions: This clinical study in a small series of ICU patients treated with ECMO confirms the usefulness of this technique as a ventilatory support in patients with refractory hypoxemic respiratory failure. However, the indication of this procedure is also committed to an ethical reflection considering the possible futility of the measure on a case-by-case basis and associated complications. SN - 2213-0071 UR - https://www.unboundmedicine.com/medline/citation/30237974/Outcomes_of_extracorporeal_membrane_oxygenation_in_adult_patients_with_hypoxemic_respiratory_failure_refractory_to_mechanical_ventilation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-0071(18)30205-3 DB - PRIME DP - Unbound Medicine ER -