Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center

Intensive Care Med. 2014 Jan;40(1):74-83. doi: 10.1007/s00134-013-3135-1. Epub 2013 Oct 30.


Purpose: Patients with severe acute respiratory distress syndrome (ARDS) are candidates for extracorporeal membrane oxygenation (ECMO) therapy. The evaluation of organ severity is difficult in patients considered for cannulation in a distant hospital. This study was designed to identify early factors associated with hospital mortality in ARDS patients treated with ECMO and retrieved from referring hospitals.

Methods: Data from 85 consecutive ARDS patients equipped with ECMO by our mobile team and consequently admitted to our ICU were prospectively collected and analyzed.

Results: The main ARDS etiologies were community-acquired bacterial pneumonia (35%), influenza pneumonia (23%) (with 12 patients having been treated during the first half of the study period), and nosocomial pneumonia (14%). The median (interquartile range) time between contact from the referring hospital and patient cannulation was 3 (1-4) h. ECMO was venovenous in 77 (91%) patients. No complications occurred during transport by our mobile unit. Forty-eight patients died at the hospital (56%). Based on a multivariate logistic regression, a score including age, SOFA score, and a diagnosis of influenza pneumonia was constructed. The probability of hospital mortality following ECMO initiation was 40% in the 0-2 score class (n = 58) and 93% in the 3-4 score class (n = 27). Patients with an influenza pneumonia diagnosis and a SOFA score before ECMO of less than 12 had a mortality rate of 22%.

Conclusions: Age, SOFA score, and a diagnosis of influenza may be used to accurately evaluate the risk of death in ARDS patients considered for retrieval under ECMO from distant hospitals.

MeSH terms

  • Adult
  • Comorbidity
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • France / epidemiology
  • Hospital Mortality*
  • Humans
  • Influenza, Human / complications*
  • Influenza, Human / mortality
  • Influenza, Human / therapy
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Organ Dysfunction Scores
  • Pneumonia / complications*
  • Pneumonia / etiology
  • Pneumonia / mortality
  • Pneumonia / therapy
  • Prognosis
  • Prospective Studies
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / mortality*
  • Respiratory Distress Syndrome / therapy*
  • Risk Assessment / methods
  • Survival Analysis