Extracorporeal membrane oxygenation for adult respiratory failure

Objectives: To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. Design: Retrospective chart review. Setting: Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center. Patients: Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995. Interventions: None. Measurements and results: Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO₂ to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre- ECMO, 76.5 (83.7 h); peak airway pressure, 30.6 (7.4) cm H₂O; end- expiratory pressure, 10 (3.3) em H₂O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p=0.036 and p=0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p=0.036). Conclusions: Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.