Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure

Hypothesis: Extracorporeal membrane oxygenation (ECMO) is effective in nonn eonatal acute respiratory failure under certain circumstances. Design: Retrospective medical. record review. Setting: The intensive care unit of a tertiary care hospital. Patients: Thirty-four nonneonatal patients (mean age, 22 years; range, 8 da ys to 56 years),with ratios of the PaO2 to the fraction of inspired oxygen persistently below 70, who were treated with ECMO after maximal ventilator therapy had failed (mean time of ventilator therapy, 6.9 days; range, 1-41 days). The mean ECMO duration was 304 hours (range, 56-934 hours). Patients were grouped into 7 categories based on their diagnosis: sepsis or sepsis syndrome (n = 3), bacterial or fungal pneumonia (n = 10), viral pneumonia ( n = 5), trauma or burn (n = 2), inhalation injury without burn (n = 1), imm unocompromised state (due to transplantation or chemotherapy) (n = 8), and acute respiratory failure of unknown origin (n = 5). Main Outcome Measure: Survival to hospital discharge following ECMO therapy . Results: Overall survival was 53% (18 patients). All 6 patients (100%) with viral pneumonias or isolated inhalation injuries survived. Of 13 patients with bacterial pneumonia, sepsis, or sepsis syndrome not complicated by mul tiorgan failure, 10 (77%) survived. In contrast, all but 1 of the immunocom promised patients died. Survival in patients who were intubated for less th an 9 days before ECMO was 64%, whereas survival fell precipitously to 22% f or patients who experienced mechanical ventilation for 9 or more days befor e the implementation of ECMO. Finally, the proportion of patients who died while receiving ECMO therapy was greater when the ECMO duration exceeded 30 0 hours (62% vs 38%; P<.05). Conclusions: Nonneonatal survival with ECMO therapy is strongly dependent o n the diagnosis. Pre-ECMO intubation for less than 9 days had little effect on survival. Survival rates decreased when the length of time of receiving ECMO exceeded 300 hours.