2008 Annual Meeting Abstracts
Extracorporeal Membrane Oxygenation for Non-neonatal Acute Respiratory Failure: The Massachusetts General Hospital Experience from 1990 to 2008
Deepika Nehra, MD, Allan M. Goldstein, MD, Daniel P. Doody, MD, Daniel P. Ryan, MD, Peter T. Masiakos, MD.
Massachusetts General Hospital, Boston, MA, USA.
Objective: To determine the efficacy of extracorporeal membrane oxygenation (ECMO) for non-neonatal acute respiratory failure.
Design: Single institution, retrospective medical record review from 1990 to 2008.
Setting: Tertiary care hospital.
Patients: Eighty-one non-neonatal patients (mean age 24 years; range 2 months to 61 years) with acute respiratory failure who failed maximal ventilator support received ECMO therapy between 1990 and 2008. Patients were grouped into 6 categories based on diagnosis: sepsis (n=8), bacterial/fungal pneumonia (n=15), viral pneumonia (n=9), trauma/burn (n=10), immunocompromise (n=15), and other (n=24).
Main Outcome Measures: Survival to hospital discharge.
Results: Overall survival was 52%. Survival was highest in patients with viral pneumonia (78%), followed by bacterial pneumonia (53%), sepsis (44%), and immunocompromise (40%). Patients treated following trauma or burns had the lowest survival (33%). The average age of survivors was 19 years, as compared to 27 years for nonsurvivors. Survival was lower in patients with multiple organ failure (37% vs. 60%), those intubated >10 days prior to initiation of ECMO (31% vs. 58%), and in patients requiring >400 hours of ECMO support (42% vs. 55%).
Conclusions: ECMO therapy improves survival in carefully selected patients with non-neonatal acute respiratory failure. Outcome is strongly dependent on diagnosis, with particularly poor survival in immunocompromised hosts and trauma/burn victims. Older age, multiple organ failure, prolonged ventilation prior to ECMO initiation, and long ECMO runs are also associated with decreased survival.