JOURNAL ARTICLE

[Factors affecting the outcome of pulmonary-acute respiratory distress syndrome patients treated with veno-venous extracorporeal membrane oxygenation]

Min Li, Li Yi, Xu Huang, Yingying Feng, Sichao Gu, Lijuan Wu, Qingyuan Zhan
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2016 March 15, 96 (10): 781-6
27055638

OBJECTIVE: To find out the factors affecting the outcome of pulmonary-acute respiratory distress syndrome (pARDS) patients treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO).

METHODS: From November 2009 to April 2014, the clinical data of patients with pARDS supported with VV-ECMO in intensive care unit of China-Japan Friendship Hospital and Chaoyang Hospital were prospectively collected and analyzed. The clinical data included general condition before VV-EMCO, VV-ECMO treatment, ventilator settings of mechanical ventilation and complications during VV-ECMO. All patients were divided into survival group and non-survival group, according to the 28 days' survival situation after VV-ECMO treatment. The clinical data of the two groups before and after VV-ECMO treatment were compared, and the factors affecting outcome of VV-ECMO treatment in the patients with pARDS were analyzed.

RESULTS: A total of twenty-five patients were enrolled in the study, of whom 14 patients survived, 11 patients died.The results showed that the proportion of immunocompromised patients with pARDS in the survival group was lower than that of non-survival group (7.1% vs 45.5%, P=0.026). Before the treatment of VV-ECMO, the duration of mechanical ventilation in the survival group was shorter than that in the non-survival group [25(7, 48) vs 48(21, 120) h, P=0.048], and Murray score was also lower than the non-survival group [3.5(3.3, 4.0) vs 4.0(3.9, 4.0), P=0.020]. During the treatment of VV-ECMO, the duration of ECMO support in the survival group was shorter than that in the non-survival group [7.0(5.0, 9.0) vs 13.0(7.8, 26.0) d, P=0.030], and the proportions of disturbance of blood coagulation and circulatory failure in the survival group were lower than those of non-survival group [0% vs 36.4%, 21.4% vs 63.6%, both P<0.05]. In addition, there were five "awake ECMO" patients during the treatment and all in the survival group.

CONCLUSION: The immunocompromised condition, pre-ECMO ventilation duration and Murray score are the important factors influencing the outcome of VV-ECMO treatment in the patients with pARDS.

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