North Pacific Surgical AssociationAdult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center
Section snippets
Methods
Our approach to ARDS is protocolized and, as much as possible, evidence based. Our goals are to use the lowest level of support to provide adequate oxygen delivery14 (Fig. 1). We use a full spectrum of ventilator modes, including ARDS Network lung-protective strategies, airway pressure release ventilation, and high-frequency percussive ventilation (HFPV) with the Volume Diffusive Respirator (VDR-4 critical care ventilator; Percussionaire Corporation, Sandpoint, ID). We also use numerous
Results
Between January 2009 and September 2012, 36 adults (aged >17 years) were treated with ECMO for ARDS at the Legacy Emanuel Medical Center. All patients were cared for by the ECMO service primarily, a surgically directed multidisciplinary team of cardiac and critical care surgeons, intensivists and specialists, perfusionists, and therapists. Thirty-two of these patients (89%) were referred from regional hospitals. Twenty-five patients (69% of the total cohort or 78% of referrals) required ECMO
Comments
The use of ECMO for adults with profound and refractory hypoxemic ARDS remains controversial despite significant advances in technology, practice, and evidence. First reported for posttraumatic ARDS30 in 1972, the early randomized trials of Zapol et al11 in 1979 and Morris et al12 in 1994 failed to show improved survival in the ECMO groups. These studies were conducted using equipment, techniques, patient selection and critical care methods that are not comparable with today's standards. In
References (44)
- et al.
Acute respiratory distress in adults
Lancet
(1967) - et al.
Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients
Am J Surg
(1995) - et al.
Efficacy and economic assessment of Conventional Ventilatory Support Versus Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR): a multicentre randomized controlled trial
Lancet
(2009) - et al.
Severe hypoxemic respiratory failure: part 2—nonventilatory strategies
Chest
(2010) - et al.
Extracorporeal membrane oxygenation in adult acute respiratory distress syndrome
Crit Care Clin
(2011) - et al.
Are the results of a regional ST-elevation myocardial infarction system reproducible?
Am J Cardiol
(2012) - et al.
Interhospital transport of the patient on extracorporeal cardiopulmonary support
Ann Thorac Surg
(1994) - et al.
A 22-year experience in global transport extracorporeal membrane oxygenation
J Pediatr Surg
(2008) - et al.
Reducing the time on ECMO with the use of the Volume Diffusive Respirator (VDR) for adults with H1N1 pneumonia
Am J Surg
(2013) - et al.
An expanded definition of the adult respiratory distress syndrome
Am Rev Respir Dis
(1988)
The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination
Am J Respir Crit Care Med
Acute respiratory distress syndrome: the Berlin definition
JAMA
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome
N Engl J Med
Positive endexpiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial
JAMA
Neuromuscular blockers in early acute respiratory distress syndrome
N Engl J Med
High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis
BMJ
Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis
Minerva Anestesiol
Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial
JAMA
Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study
JAMA
Randomized clinical trial of pressure controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome
Am J Respir Crit Care Med
A protocolized approach to pulmonary failure and the role of intermittent prone positioning
J Trauma
Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A (H1N1)
JAMA
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The authors declare no conflicts of interest.