Hemodynamic Improvement in Acute Respiratory Distress Syndrome Patients After Venovenous Extracorporeal Membrane Oxygenation Implantation

Abstract

Objective: Severe acute respiratory distress syndrome (ARDS) is often complicated by hemodynamic instability requiring pharmacological support. Venovenous extracorporeal membrane oxygenation (VV ECMO) is a well-established technique that contributes to improved outcomes in this population. However, the effects of VV ECMO on inotropic and vasoconstrictor requirements have never been addressed in a large case series.

Design: Observational study.

Setting: University hospital.

Participants: Consecutive adult ARDS patients treated with VV ECMO.

Measurements and main results: From June 2009 to October 2023, 118 ARDS patients received VV ECMO and had available baseline data. The median patient age was 57 years, 65% of patients were male, and 76% had ongoing inotropic and/or vasoconstrictor support. Two hours after ECMO implantation, 61% of patients showed hemodynamic improvement, as documented by the reduced need for catecholaminergic support or increased mean arterial pressure with identical inotropic and/or vasoconstrictor support. This percentage increased to 63% at 12 hours, 83% at 24 hours, and 85% at 48 hours.

Conclusion: In the first 2 hours after VV ECMO implantation, hemodynamic improvement was observed in the majority of ARDS patients. This positive effect might therefore be considered in the decision-making process for VV ECMO implantation.

Keywords: Vasoactive Inotropic Score; acute respiratory distress syndrome; extracorporeal membrane oxygenation; hemodynamic; intensive care; respiratory failure; right ventricular failure; septic shock.