Three-year experience of using venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2014-10, Vol.20 (5), p.407-412
• Main Authors: Ng, George W Y, Leung, Anne K H, Sin, K C, Au, S Y, Chan, Stanley C H, Chan, Osburga P K, Wu, Helen H L
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anticoagulants; Bacterial infections; Catheters; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Female; Hemoglobin; Hong Kong; Humans; Infections; Influenza A Virus, H1N1 Subtype; Influenza, Human - mortality; Influenza, Human - therapy; Intensive care; Intensive Care Units; Male; Mortality; Nurses; Pneumonia; Pneumonia, Viral - mortality; Pneumonia, Viral - therapy; Respiratory failure; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Statistical analysis; Surgical apparatus & instruments; Treatment Outcome; Ventilators; Viral infections
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj144211

To present the 3-year experience of using venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure in a single centre in Hong Kong. Case series. A 19-bed Intensive Care Unit of a tertiary hospital in Hong Kong. All patients who were managed with venovenous extracorporeal membrane oxygenation from 1 July 2010 to 30 June 2013 in the Intensive Care Unit. Overall, 31 patients (mean age, 42.2 years, standard deviation, 14.1 years; 21 males) received venovenous extracorporeal membrane oxygenation for the treatment of severe respiratory failure. Of these, 90.3% (28 patients) presented with pneumonia as the cause of the respiratory failure, and 22 of them had identifiable causes. A total of nine (29.0%) patients were diagnosed to have H1N1 infection. The median Murray score was 3.5 (interquartile range, 3.0-3.5); the median duration of venovenous extracorporeal membrane oxygenation support was 5.0 (2.8-8.6) days; and the median duration of mechanical ventilator support was 18.2 (7.8-27.9) days. The overall intensive care unit mortality was 19.4% (n=6). The overall in-hospital mortality and the 28-day mortality were both 22.6% (n=7). Among the 22 patients who had identifiable infective causes, those suffering from viral infection had lower intensive care unit and hospital mortality than those who had bacterial infection (8.3% vs 20.0%). All the H1N1 patients survived. Complications related to extracorporeal membrane oxygenation included severe bleeding (n=2; 6.5%) and mechanical complications of the circuits (n=3; 9.7%). Venovenous extracorporeal membrane oxygenation is an effective adjunctive therapy and can be used as a life-saving procedure for carefully selected patients with severe acute respiratory distress syndrome when the limits of standard therapy have been reached.