Extracorporeal Membrane Oxygenation for Nonneonatal Acute Respiratory Failure: The Massachusetts General Hospital Experience From 1990 to 2008 | Critical Care Medicine | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.204.227.34. Please contact the publisher to request reinstatement.
1.
Bernard  GRArtigas  ABrigham  KL  et al. Consensus Committee, Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination.  J Crit Care 1994;9 (1) 72- 81PubMedGoogle Scholar
2.
Rubenfeld  GDCaldwell  EPeabody  E  et al.  Incidence and outcomes of acute lung injury.  N Engl J Med 2005;353 (16) 1685- 1693PubMedGoogle Scholar
3.
Hemmila  MRNapolitano  LM Severe respiratory failure: advanced treatment options.  Crit Care Med 2006;34 (9) ((suppl)) S278- S290PubMedGoogle Scholar
4.
Amato  MBBarbas  CSMedeiros  DM  et al.  Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med 1998;338 (6) 347- 354PubMedGoogle Scholar
5.
Ullrich  RLorber  CRoder  G  et al.  Controlled airway pressure therapy, nitric oxide inhalation, prone position, and extracorporeal membrane oxygenation (ECMO) as components of an integrated approach to ARDS.  Anesthesiology 1999;91 (6) 1577- 1586PubMedGoogle Scholar
6.
Rubenfeld  GDHerridge  MS Epidemiology and outcomes of acute lung injury.  Chest 2007;131 (2) 554- 562PubMedGoogle Scholar
7.
Kopp  RDembinski  RKuhlen  R Role of extracorporeal lung assist in the treatment of acute respiratory failure.  Minerva Anestesiol 2006;72 (6) 587- 595PubMedGoogle Scholar
8.
UK Collaborative ECMO Trial Group, UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation.  Lancet 1996;348 (9020) 75- 82PubMedGoogle Scholar
9.
UK Collaborative ECMO Group, The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age.  Pediatrics 1998;101 (4) E1PubMed10.1542/peds.101.4.e1Google Scholar
10.
Mols  GLoop  TGeiger  KFarthmann  EBenzing  A Extracorporeal membrane oxygenation: a ten-year experience.  Am J Surg 2000;180 (2) 144- 154PubMedGoogle Scholar
11.
Masiakos  PTIslam  SDoody  DPSchnitzer  JJRyan  DP Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure.  Arch Surg 1999;134 (4) 375- 380PubMedGoogle Scholar
12.
Macha  MGriffith  BPKeenan  R  et al.  ECMO support for adult patients with acute respiratory failure.  ASAIO J 1996;42 (5) M841- M844PubMedGoogle Scholar
13.
Green  TPTimmons  ODFackler  JCMoler  FWThompson  AESweeney  MFPediatric Critical Care Study Group, The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure.  Crit Care Med 1996;24 (2) 323- 329PubMedGoogle Scholar
14.
Peek  GJMoore  HMMoore  NSosnowski  AWFirmin  RK Extracorporeal membrane oxygenation for adult respiratory failure.  Chest 1997;112 (3) 759- 764PubMedGoogle Scholar
15.
Zapol  WMSnider  MTHill  JD  et al.  Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study.  JAMA 1979;242 (20) 2193- 2196PubMedGoogle Scholar
16.
Morris  AHWallace  CJMenlove  RL  et al.  Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.  Am J Respir Crit Care Med 1994;149 (2, pt 1) 295- 305PubMedGoogle Scholar
17.
Pranikoff  THirschl  RBSteimle  CNAnderson  HL  IIIBartlett  RH Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure.  Crit Care Med 1997;25 (1) 28- 32PubMedGoogle Scholar
Paper
May 18, 2009

Extracorporeal Membrane Oxygenation for Nonneonatal Acute Respiratory Failure: The Massachusetts General Hospital Experience From 1990 to 2008

Author Affiliations

Author Affiliations: Divisions of Pediatric Surgery (Drs Nehra, Goldstein, Doody, Ryan, and Masiakos) and General Medicine (Dr Chang), Massachusetts General Hospital, Boston.

Arch Surg. 2009;144(5):427-432. doi:10.1001/archsurg.2009.45
Abstract

Objective  To determine the efficacy of extracorporeal membrane oxygenation (ECMO) for nonneonatal acute respiratory failure.

Design  Single-institution, retrospective medical record review from February 1990 to March 2008.

Setting  Tertiary care hospital.

Patients  Eighty-one nonneonatal patients (mean age, 23 years; age range, 2 months to 61 years) with acute respiratory failure who had failed maximal ventilator support received ECMO therapy between 1990 and 2008. Patients were grouped into 6 categories based on diagnosis: sepsis (n = 8), bacterial or fungal pneumonia (n = 15), viral pneumonia (n = 9), trauma or burn (n = 10), immunocompromise (n = 15), and other (n = 24).

Main Outcome Measure  Survival to hospital discharge.

Results  Overall survival was 53%. Survival was highest in patients with viral pneumonia (78%), followed by bacterial pneumonia (53%), sepsis syndrome (44%), and immunocompromise (40%). Patients treated following trauma or burns had the lowest survival (33%). The average age was 19 years for survivors as compared with 27 years for nonsurvivors. Survival was lower in patients with multiple organ failure as compared with those with single organ failure (33% vs 60%, respectively), in patients who experienced mechanical ventilation for longer than 10 days prior to the initiation of ECMO as compared with those who received ventilatory support for less than 10 days prior to the initiation of ECMO (31% vs 57%, respectively), and in patients requiring more than 400 hours of ECMO support as compared with those requiring less than 400 hours of ECMO support (42% vs 55%, respectively).

Conclusions  Therapy with ECMO may provide a survival benefit in carefully selected patients with nonneonatal acute respiratory failure who have failed maximal ventilator support. Nonneonatal survival with ECMO therapy is strongly dependent on diagnosis, with the highest survival seen in those with viral or bacterial pneumonia. Older age, multiple organ failure, prolonged ventilation prior to ECMO initiation, and long ECMO runs are associated with decreased survival.

×