Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study
박승용 (전북대학교)
김화정 (울산대학교)
백문성 (한림대학교)
정치량 (삼성서울병원)
박소희 (강동경희대학교병원)
강병주 (울산대학교)
오진영 (동국대학교)
조우현 (부산대학교)
심윤수 (한림대학교부속강남성심병원)
조영재 (분당서울대학교병원)
박성훈 (한림대학교)
김정현 (차의과학대학교 분당차병원)
홍상범 (울산대학교)
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Abstract
Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/ fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02–0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.
- keywords
- Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome, Adult, Respiration, Artificial, Retrospective Studies, Multicenter Studies as Topic
참고문헌
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