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Peter T. Masiakos, MD; Saleem Islam, MD; Daniel P. Doody, MD; Jay J. Schnitzer, MD, PhD; Daniel P. Ryan, MD

Arch Surg. 1999;134:375-380.

Hypothesis  Extracorporeal membrane oxygenation (ECMO) is effective in nonneonatal 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 days 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), immunocompromised 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 multiorgan failure, 10 (77%) survived. In contrast, all but 1 of the immunocompromised patients died. Survival in patients who were intubated for less than 9 days before ECMO was 64%, whereas survival fell precipitously to 22% for patients who experienced mechanical ventilation for 9 or more days before the implementation of ECMO. Finally, the proportion of patients who died while receiving ECMO therapy was greater when the ECMO duration exceeded 300 hours (62% vs 38%; P<.05).

Conclusions  Nonneonatal survival with ECMO therapy is strongly dependent on 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.

From the Department of Surgery, Pediatric Surgical Service, Massachusetts General Hospital, Harvard Medical School, Boston.

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