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 Hospi tal, and to compare them with published series of patients receiving p ositive pressure ventilation. Design: Retrospective chart review. Sett ing: Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center. Patients: Fifty cons ecutive 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 H g; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressu re, 39.6 (7.4) cm H2O; end-expiratory pressure, 10 (3.3) cm H2O; minut e 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). Survi val was significantly better than two previously reported series of pa tients 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 w ith ECMO is 66% for adults with severe respiratory failure. ECMO shoul d be considered in patients who remain hypoxic despite maximal positiv e pressure ventilation.