ECMO in ARDS management; our case and experience

• Published in: Journal of critical care 2024-06, Vol.81, p.154649, Article 154649
• Main Authors: Taskiran, Imren, San, Yosun, Baydar, Yildiz Tezel, Ediboglu, Ozlem, Kirakli, Cenk
• Format: Article
• Language: English
• Subjects: ARDS; COVID-19; ECMO; Extracorporeal membrane oxygenation; Hospitalization; Hypoxemia; Intensive care; Intubation; Respiratory distress syndrome
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154649

Acute Respiratory Distress Syndrome (ARDS) is an inflammatory condition in the lungs that can be resistant and result in life-threatening respiratory failure. Extracorporeal membrane oxygenation (ECMO) is an alternative treatment option in severe ARDS cases where adequate improvement is not observed with conventional mechanical ventilation. In our evaluation, age, gender, comorbidities, causes of ARDS, hospital and intensive care hospitalization times, invasive mechanical ventilation duration, ECMO application times, withdrawal from ECMO and intensive care discharge status of 45 patients who were diagnosed with ARDS and underwent ECMO in the follow-up were analyzed retrospectively. Physical examination, chest X-ray and thorax computed tomography images, PaO2/FiO2 ratios and PEEP values were used for the diagnosis of the patients. Between January 2010–March 2022, SBU Izmir Dr. Suat Seren Chest Diseases and Surgery Hospital, intensive care unit of 45 cases diagnosed with ARDS and applied ECMO in their follow-up were analyzed. The mean age of the patients was 46 ± 15.8, of which 35 were male and 10 were female. Apachee – II averages were calculated as 17 ± 8.1. The median IMV time was 23 (range 3–92 days), and the ECMO time was 16 ± 11.1. ECMO support was terminated in 11 (24,4) patients and 8 (17,7) patients were discharged from our hospital with survival. 16 of our patients who underwent ECMO were before the COVID-19 pandemic between January 2010 and March 2020. Due to our ARDS cases increasing with the pandemic process, we applied ECMO to 29 of our cases in the last year. We considered and evaluated non-COVID - 19 cases and COVID - 19 cases separately. And patients with COVID-19 had significantly higher Apachee – II averages and Mc Murrey scores, and longer IMV, ECMO, hospital and ICU length of stay compared to the other group. There was no significant difference in mortality between the two groups. A significant proportion of ARDS patients (refractory hypoxemia, cardiogenic shock, or septic shock) may require the use of ECMO. Correct application, appropriate patient selection, appropriate follow-up and timing are important in the success of ECMO. While COVID-19 is a serious global health problem with the pandemic process and the number of ARDS cases we encounter has increased significantly, ECMO is of great importance in the treatment of ARDS. As a result, ECMO can be used in ARDS and other indications where conventional therapy has failed.