HIGH SURVIVAL RATE IN 122 ARDS PATIENTS MANAGED ACCORDING TO A CLINICAL ALGORITHM INCLUDING EXTRACORPOREAL MEMBRANE-OXYGENATION

Objective: We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory d istress syndrome (ARDS). Design: Uncontrolled prospective trial. Setti ng: One university hospital intensive care department. Patients and pa rticipants: 122 patients with ARDS, consecutively admitted to the ICU. Interventions: ARDS was treated according to a criteria-defined clini cal algorithm. The algorithm distinguished two main treatment groups: The AT-sine-ECMO (advanced treatment without extracorporeal membrane o xygenation) group (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) u sing heparin-coated systems. Measurements and results: The groups diff ered in both APACHE II (16 +/- 5 vs 18 +/- 5 points, p = 0.01) and Mur ray scores (3.2 +/- 0.3 vs 3.4 +/- 0.3 points, p = 0.0001), the durati on of mechanical ventilation prior to admission (10 +/- 9 vs 13 +/- 9 days, p = 0.0151), and length of ICU stay in Berlin (31 +/- 17 vs 50 /- 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 +/- 27 mm Hg in AT-s ine-ECMO patients that improved to 165 +/- 107 mm Hg on ICU day 1, whi le ECMO patients showed an initial PaO2/FIO2 of 67 +/- 28 mm Hg and im provement to 160 +/- 102 mm Hg was not reached until ICU day 13. Qs/Q( T) was significantly higher in the ECMO-treated group and exceeded 50 % during the first 14 ICU days. The overall survival rate in our 122 A RDS patients was 75 %. Survival rates were 89 % in the AT-sine ECMO gr oup and 55 % in the ECMO treatment group (p = 0.0000). Conclusions: We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.