Venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe acute respiratory distress syndrome (ARDS) in adults—a single-center experience

Abstract

Abstract Background The survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with severe acute respiratory distress syndrome (ARDS) remains controversial. This study aimed to investigate the efficiency and potential prognostic factors of VV-ECMO for severe ARDS in adults by evaluating our institutional experience and results. Materials and methods This research studied ARDS patients receiving VV-ECMO between June 2011 and May 2023. The inclusion criteria were PaO2/FiO2 < 100 mmHg at FiO2 of 1.0. Retrospective data was analyzed to identify factors associated with successful ECMO weaning and hospital discharge survival. Results A total of 18 patients were included in this study, with 7 cases (38.9%) successfully weaned from ECMO and 5 cases (27.8%) surviving hospital discharge. The overall complication rate was 77.8%. After treatment with VV ECMO, there were statistically significant improvements in both PaO2 and PaCO2 (P < 0.05). Patients in the successful weaning group had a lower pTB value, less accumulative volume of sodium bicarbonate during ECMO, and lower accumulative volume of intravenous immunoglobulin in the hospital compared to the unsuccessful weaning group (all P < 0.05). Furthermore, compared to the non-survivors, the survivors had less severe acidosis, higher mean arterial pressure before ECMO, a lower level of pCr, and a lower pTB value during ECMO (all P < 0.05). Conclusion ECMO can effectively promote oxygenation and carbon dioxide (CO2) removal in patients with severe ARDS. Early initiation of ECMO with appropriate management could benefit in reducing comorbidities and mortality.

Keywords

• Venovenous extracorporeal membrane oxygenation
• Acute respiratory distress syndrome
• Complications
• Mortality
• Prognostic factors