Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange.

OBJECTIVE: To evaluate the effect of extracorporeal gas exchange (ECMO) on mortality of patients referred with severe acute respiratory distress syndrome (ARDS).

DESIGN AND SETTING: Prospective observational study in a university hospital ICU.

PATIENTS: 150 patients with severe ARDS.

INTERVENTIONS: Multimodal treatment with and without ECMO.

MEASUREMENTS AND MAIN RESULTS: We treated 118 patients (78.7%) conservatively and 32 patients with ECMO. Patients in the ECMO group presented with significantly more severe disease (lung injury score 3.8+/-0.3 vs. 3.3+/-0.4; SOFA score 52+/-14 vs. 43+/-12; and SAPS score 14+/-3.3 vs. 10+/-3.5). Mortality in ECMO-treated patients tended to be higher than that with conservative treatment (46.9% vs. 28.8%, p=0.059). Multivariate logistic regression analyses with backward selection excluded ECMO as predictor of mortality (p=0.79). Independent predictors of mortality were age (odds ratio 1.044, 95% confidence interval 1.014-1.075, p=0.004), mean pulmonary artery pressure (1.082, 1.026-1.141, p=0.036), sequential organ failure assessment score (1.148, 1.018-1.294, p=0.024), and days of mechanical ventilation prior to referral (1.064, 1.008-1.123, p=0.025).

CONCLUSION: ECMO treatment does not predict mortality in patients with most severe ARDS.