Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in Adults: Prognostic Factors for Outcomes

Despite a therapeutic option for severe acute respiratory distress syndrome (ARDS), the survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) is still controversial in adults. This study was aimed at investigating the prognostic factors for ECMO-treated ARDS in adult patients. From 2012 to 2015, 49 patients (median age: 57 years) received VV-ECMO in our institution and were included in this retrospective study. The indication of VV-ECMO was a severe hypoxemia (P(a)O(2)/FiO(2) ratio <70 mmHg) under mechanical ventilation (MV) with a peak inspiratory pressure (PIP) >35 cmH(2)O and a F(i)O(2) >0.8. To decrease the impact of pulmonary injuries associated with the high-pressure ventilation, the settings of MV on VV-ECMO were downgraded according to our protocol. Outcomes of this study were death on VV-ECMO and death in hospital. Important demographic and clinical data during the treatment were collected for outcome analyses. All patients experienced significant improvements in arterial oxygenation on VV-ECMO. Twenty-four hours after initiation of VV-ECMO, the median P(a)O(2)/FiO(2) ratio increased from 58 to 172 mmHg (P < 0.001) and the median S(a)O(2) increased from 86% to 97% (P < 0.001). In the meantime, the MV settings were also effectively downgraded. The median PIP decreased from 35 to 29 cmH(2)O (P < 0.001) and the median tidal volume decreased from 7 to 5 ml/kg/min (P < 0.001). Twelve patients died during the treatment of VV-ECMO and 21 patients died before hospital discharge. Among all of the pre-ECMO variables, the pre-ECMO pulmonary dynamic compliance (PC(dyn)) <20 mL/cmH(2)O was identified to be the prognostic factor of death on VV-ECMO (odds ratio [OR]: 6, 95% confidence interval [CI]: 1–35, P = 0.03), and the pre-ECMO duration of MV >90 hours was the prognostic factor of death before hospital discharge (OR: 7, 95% CI: 1–29, P = 0.01). VV-ECMO was a useful salvage therapy for severe ARDS in adults. However, the value of PC(dyn) and the duration of MV before intervention with VV-ECMO may significantly affect the patients’ outcomes.