Severity and outcome of ARDS: the present place of extracorporeal lung assist (ECLA)

Abstract

Within the last decade extracorporeal lung assist has been recommended for the treatment of acute respiratory distress syndrome. However, this recommendation was challenged by several recent clinical studies and reviews. The goal of our analysis was therefore to investigate data on outcome and severity of gas exchange disturbance published from patients treated with ECLA. These data were compared to a historical control group consisting of ARDS patients treated conventionally. Computerized (MEDLINE 1967-95) literature search using the keywords ARDS, ECLA, ECMO, ECCO2R and HUMAN was performed. Only clinical studies published as full papers reporting data on both, patients mortality and oxygenation index (PaO2/FiO2) were included. Overall mean mortality reported was 53 +/- 22% in 17 studies (419 patients), with no apparent trend towards a higher survival within the last decade with a mean PaO2/FIO2 (14 papers; 61 +/- 17 mmHg). However, mean mortality rates of ARDS patients requiring ECLA was 52.3% and 44.9% if patients undergoing ECMO were excluded (3 papers). Therefore the mortality of these patients with severe lung injury was in the range of patients treated conventionally. Patient outcome observed in our analysis is in accordance with the mortality rates from the European ECLA centres published recently (49% in 1993). Therefore, we conclude that the mean mortality rate of patients suffering from severe ARDS treated with ECLA is in the 50% range and does not differ significantly from those of patients treated conventionally, despite significantly poorer pulmonary function.