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. 2014 Jan;40(1):74-83.
doi: 10.1007/s00134-013-3135-1. Epub 2013 Oct 30.

Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center

Antoine Roch  1 , Sami Hraiech, Elodie Masson, Dominique Grisoli, Jean-Marie Forel, Mohamed Boucekine, Pierre Morera, Christophe Guervilly, Mélanie Adda, Stéphanie Dizier, Richard Toesca, Fréderic Collart, Laurent Papazian
Affiliations

Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center

Antoine Roch et al. Intensive Care Med. 2014 Jan.

Abstract

Purpose: Patients with severe acute respiratory distress syndrome (ARDS) are candidates for extracorporeal membrane oxygenation (ECMO) therapy. The evaluation of organ severity is difficult in patients considered for cannulation in a distant hospital. This study was designed to identify early factors associated with hospital mortality in ARDS patients treated with ECMO and retrieved from referring hospitals.

Methods: Data from 85 consecutive ARDS patients equipped with ECMO by our mobile team and consequently admitted to our ICU were prospectively collected and analyzed.

Results: The main ARDS etiologies were community-acquired bacterial pneumonia (35%), influenza pneumonia (23%) (with 12 patients having been treated during the first half of the study period), and nosocomial pneumonia (14%). The median (interquartile range) time between contact from the referring hospital and patient cannulation was 3 (1-4) h. ECMO was venovenous in 77 (91%) patients. No complications occurred during transport by our mobile unit. Forty-eight patients died at the hospital (56%). Based on a multivariate logistic regression, a score including age, SOFA score, and a diagnosis of influenza pneumonia was constructed. The probability of hospital mortality following ECMO initiation was 40% in the 0-2 score class (n = 58) and 93% in the 3-4 score class (n = 27). Patients with an influenza pneumonia diagnosis and a SOFA score before ECMO of less than 12 had a mortality rate of 22%.

Conclusions: Age, SOFA score, and a diagnosis of influenza may be used to accurately evaluate the risk of death in ARDS patients considered for retrieval under ECMO from distant hospitals.

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Figures

Fig. 1
Fig. 1
Study flowchart. ARDS acute respiratory disease syndrome, ECMO extracorporeal membrane oxygenation
Fig. 2
Fig. 2
Distribution of SOFA score and subscores before ECMO in survivors (white bars) and in nonsurvivors (black bars). The neurological score was 0 and the respiratory score was 4 in all patients
Fig. 3
Fig. 3
Kaplan–Meier estimates of cumulative probabilities of survival for patients with pre-ECMO score classes 0–2 (n = 58), and 3–4 (n = 27). ECMO extracorporeal membrane oxygenation
See this image and copyright information in PMC

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