. 2021 May 26;11(6):393.

doi: 10.3390/membranes11060393.

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Li-Chung Chiu^{1

2

3}, Li-Pang Chuang¹, Shaw-Woei Leu¹, Yu-Jr Lin⁴, Chee-Jen Chang^{4

5}, Hsin-Hsien Li^{6

7}, Feng-Chun Tsai⁸, Chih-Hao Chang^{1

3}, Chen-Yiu Hung^{1

3}, Shih-Wei Lin¹, Han-Chung Hu^{1

6

9}, Chung-Chi Huang^{1

6

9}, Huang-Pin Wu¹⁰, Kuo-Chin Kao^{1

6

9}

Affiliations

¹ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
³ Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung University, Taoyuan 33302, Taiwan.
⁴ Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan.
⁵ Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan.
⁶ Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan.
⁷ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.
⁸ Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
⁹ Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.

PMID: 34073487
PMCID: PMC8227965
DOI: 10.3390/membranes11060393

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Li-Chung Chiu et al. Membranes (Basel). 2021.

. 2021 May 26;11(6):393.

doi: 10.3390/membranes11060393.

Authors

Affiliations

¹ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
³ Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung University, Taoyuan 33302, Taiwan.
⁴ Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan.
⁵ Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan.
⁶ Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan.
⁷ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.
⁸ Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
⁹ Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.

PMID: 34073487
PMCID: PMC8227965
DOI: 10.3390/membranes11060393

Abstract

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

Keywords: acute respiratory distress syndrome; extracorporeal membrane oxygenation; mortality; propensity score matching analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Flow diagram showing the enrollment of patients with severe ARDS who were or were not administered ECMO support via propensity score matching. (ARDS, acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation).

**Figure 2**
Kaplan-Meier 90-d survival curves of patients who did or did not receive ECMO support for severe acute respiratory distress syndrome: (a) before propensity score matching; (b) after propensity score matching. (ECMO, extracorporeal membrane oxygenation).

**Figure 3**
Subgroup analysis of hospital mortality as a function of baseline clinical variables. (BMI, body mass index; CI, confidence interval; ECMO, extracorporeal membrane oxygenation; FiO₂, fraction of inspired oxygen; OR, odds ratio; PaO₂, partial pressure of oxygen in arterial blood; PEEP, positive end-expiratory pressure; SOFA, sequential organ failure assessment).

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Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

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Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

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Abstract

Conflict of interest statement

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Abstract

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