Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study

  • Kim, Won-Young (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University, School of Medicine) ;
  • Park, SeungYong (Department of Internal Medicine, Chonbuk National University Medical School) ;
  • Kim, Hwa Jung (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Baek, Moon Seong (Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital) ;
  • Chung, Chi Ryang (Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, So Hee (Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Kang, Byung Ju (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Oh, Jin Young (Division of Pulmonology and Critical Care Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Cho, Woo Hyun (Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital) ;
  • Sim, Yun Su (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Cho, Young-Jae (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Park, Sunghoon (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital) ;
  • Kim, Jung-Hyun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Hong, Sang-Bum (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.07.24
  • Accepted : 2018.10.25
  • Published : 2019.07.31
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Abstract

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

Keywords

References

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