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Ann Surg. Oct 1997; 226(4): 544–566.
PMCID: PMC1191077

Extracorporeal life support for 100 adult patients with severe respiratory failure.

Abstract

OBJECTIVE: The authors retrospectively reviewed their experience with extracorporeal life support (ECLS) in 100 adult patients with severe respiratory failure (ARF) to define techniques, characterize its efficacy and utilization, and determine predictors of outcome. SUMMARY BACKGROUND DATA: Extracorporeal life support maintains gas exchange during ARF, providing diseased lungs an optimal environment in which to heal. Extracorporeal life support has been successful in the treatment of respiratory failure in infants and children. In 1990, the authors instituted a standardized protocol for treatment of severe ARF in adults, which included ECLS when less invasive methods failed. METHODS: From January 1990 to July 1996, the authors used ECLS for 100 adults with severe acute hypoxemic respiratory failure (n = 94): paO2/FiO2 ratio of 55.7+/-15.9, transpulmonary shunt (Qs/Qt) of 52+/-22%, or acute hypercarbic respiratory failure (n = 6): paCO2 84.0+/-31.5 mmHg, despite and after maximal conventional ventilation. The technique included venovenous percutaneous access, lung "rest," transport on ECLS, minimal anticoagulation, hemofiltration, and optimal systemic oxygen delivery. RESULTS: Overall hospital survival was 54%. The duration of ECLS was 271.9+/-248.6 hours. Primary diagnoses included pneumonia (49 cases, 53% survived), adult respiratory distress syndrome (45 cases, 51 % survived), and airway support (6 cases, 83% survived). Multivariate logistic regression modeling identified the following pre-ECLS variables significant independent predictors of outcome: 1) pre-ECLS days of mechanical ventilation (p = 0.0003), 2) pre-ECLS paO2/FiO2 ratio (p = 0.002), and 3) age (years) (p = 0.005). Modeling of variables during ECLS showed that no mechanical complications were independent predictors of outcome, and the only patient-related complications associated with outcome were the presence of renal failure (p < 0.0001) and significant surgical site bleeding (p = 0.0005). CONCLUSIONS: Extracorporeal life support provides life support for ARF in adults, allowing time for injured lungs to recover. In 100 patients selected for high mortality risk despite and after optimal conventional treatment, 54% survived. Extracorporeal life support is extraordinary but reasonable treatment in severe adult respiratory failure. Predictors of survival exist that may be useful for patient prognostication and design of future prospective studies.

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  • Green TP, Timmons OD, Fackler JC, Moler FW, Thompson AE, Sweeney MF. The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Crit Care Med. 1996 Feb;24(2):323–329. [PubMed]
  • Hill JD, O'Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, Gerbode F. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972 Mar 23;286(12):629–634. [PubMed]
  • Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Peirce EC, 2nd, Thomas AN, Proctor HJ, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979 Nov 16;242(20):2193–2196. [PubMed]
  • Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, Iapichino G, Romagnoli G, Uziel L, Agostoni A, et al. Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA. 1986 Aug 15;256(7):881–886. [PubMed]
  • Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF, Jr, Weaver LK, Dean NC, Thomas F, East TD, Pace NL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):295–305. [PubMed]
  • Brunet F, Belghith M, Mira JP, Lanore JJ, Vaxelaire JF, Dall'ava Santucci J, Dhainaut JF. Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome. Chest. 1993 Sep;104(3):889–898. [PubMed]
  • Brunet F, Mira JP, Belghith M, Monchi M, Renaud B, Fierobe L, Hamy I, Dhainaut JF, Dall'ava-Santucci J. Extracorporeal carbon dioxide removal technique improves oxygenation without causing overinflation. Am J Respir Crit Care Med. 1994 Jun;149(6):1557–1562. [PubMed]
  • Shanley CJ, Hirschl RB, Schumacher RE, Overbeck MC, Delosh TN, Chapman RA, Coran AG, Bartlett RH. Extracorporeal life support for neonatal respiratory failure. A 20-year experience. Ann Surg. 1994 Sep;220(3):269–282. [PMC free article] [PubMed]
  • Moler FW, Custer JR, Bartlett RH, Palmisano J, Meliones JN, Delius RE, Braden EI, Snedecor S. Extracorporeal life support for pediatric respiratory failure. Crit Care Med. 1992 Aug;20(8):1112–1118. [PubMed]
  • Anderson HL, 3rd, Delius RE, Sinard JM, McCurry KR, Shanley CJ, Chapman RA, Shapiro MB, Rodriguez JL, Bartlett RH. Early experience with adult extracorporeal membrane oxygenation in the modern era. Ann Thorac Surg. 1992 Apr;53(4):553–563. [PubMed]
  • Anderson H, 3rd, Steimle C, Shapiro M, Delius R, Chapman R, Hirschl R, Bartlett R. Extracorporeal life support for adult cardiorespiratory failure. Surgery. 1993 Aug;114(2):161–173. [PubMed]
  • Shapiro MB, Kleaveland AC, Bartlett RH. Extracorporeal life support for status asthmaticus. Chest. 1993 Jun;103(6):1651–1654. [PubMed]
  • Pranikoff T, Hirschl RB, Steimle CN, Anderson HL, 3rd, Bartlett RH. Efficacy of extracorporeal life support in the setting of adult cardiorespiratory failure. ASAIO J. 1994 Jul-Sep;40(3):M339–M343. [PubMed]
  • Kolla S, Lee WA, Hirschl RB, Bartlett RH. Extracorporeal life support for cardiovascular support in adults. ASAIO J. 1996 Sep-Oct;42(5):M809–M819. [PubMed]
  • Shanley CJ, Bartlett RH. The management of acute respiratory failure. Curr Opin Gen Surg. 1994:7–16. [PubMed]
  • Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818–824. [PubMed]
  • Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967 Aug 12;2(7511):319–323. [PubMed]
  • Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1818–1824. [PubMed]
  • Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med. 1990;16(6):372–377. [PubMed]
  • Vasilyev S, Schaap RN, Mortensen JD. Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey. Chest. 1995 Apr;107(4):1083–1088. [PubMed]
  • Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988 Sep;138(3):720–723. [PubMed]
  • Bartlett RH, Morris AH, Fairley HB, Hirsch R, O'Connor N, Pontoppidan H. A prospective study of acute hypoxic respiratory failure. Chest. 1986 May;89(5):684–689. [PubMed]
  • Morel DR, Dargent F, Bachmann M, Suter PM, Junod AF. Pulmonary extraction of serotonin and propranolol in patients with adult respiratory distress syndrome. Am Rev Respir Dis. 1985 Sep;132(3):479–484. [PubMed]
  • UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet. 1996 Jul 13;348(9020):75–82. [PubMed]
  • Timmons OD, Dean JM, Vernon DD. Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr. 1991 Dec;119(6):896–899. [PubMed]
  • Hirschl RB, Pranikoff T, Gauger P, Schreiner RJ, Dechert R, Bartlett RH. Liquid ventilation in adults, children, and full-term neonates. Lancet. 1995 Nov 4;346(8984):1201–1202. [PubMed]
  • Hirschl RB, Pranikoff T, Wise C, Overbeck MC, Gauger P, Schreiner RJ, Dechert R, Bartlett RH. Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA. 1996 Feb 7;275(5):383–389. [PubMed]
  • Lennartz H. Extracorporeal lung assist in ARDS: history and state of the art. Acta Anaesthesiol Scand Suppl. 1996;109:114–116. [PubMed]
  • Peek GJ, Firmin RK. Extracorporeal membrane oxygenation, a favourable outcome? Br J Anaesth. 1997 Mar;78(3):235–237. [PubMed]
  • Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis. 1987 Feb;135(2):312–315. [PubMed]
  • Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988 May;137(5):1159–1164. [PubMed]
  • Barber RE, Hamilton WK. Oxygen toxicity in man. A A/Barber RE, Lee J, Hamilton WK: Oxygen toxicity in man. A prospective study in patients with irreversible brain damage. N Engl J Med. 1970 Dec 31;283(27):1478–1484. [PubMed]
  • Pranikoff T, Hirschl RB, Steimle CN, Anderson HL, 3rd, Bartlett RH. Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure. Crit Care Med. 1997 Jan;25(1):28–32. [PubMed]
  • Mellgren K, Friberg LG, Mellgren G, Hedner T, Wennmalm A, Wadenvik H. Nitric oxide in the oxygenator sweep gas reduces platelet activation during experimental perfusion. Ann Thorac Surg. 1996 Apr;61(4):1194–1198. [PubMed]
  • Bone RC, Balk R, Slotman G, Maunder R, Silverman H, Hyers TM, Kerstein MD. Adult respiratory distress syndrome. Sequence and importance of development of multiple organ failure. The Prostaglandin E1 Study Group. Chest. 1992 Feb;101(2):320–326. [PubMed]

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