Treatment of severe acute respiratory distress syndrome: Role of extracorporeal gas exchange

Objective: To evaluate the effect of extracorporeal gas exchange (ECMO) on mortality of patients referred with severe acute respiratory distress syndrome (ARDS). Design and setting: Prospective observational study in a university hospital ICU. Patients: 150 patients with severe ARDS. Interventions: Multimodal treatment with and without ECMO. Measurements and main results: We treated 118 patients (78.7%) conservatively and 32 patients with ECMO. Patients in the ECMO group presented with significantly more severe disease (lung injury score 3.8 ± 0.3 vs. 3.3 ± 0.4; SOFA score 52 ± 14 vs. 43 ± 12; and SAPS score 14 ± 3.3 vs. 10 ± 3.5). Mortality in ECMO-treated patients tended to be higher than that with conservative treatment (46.9% vs. 28.8%, p = 0.059). Multivariate logistic regression analyses with backward selection excluded ECMO as predictor of mortality (p = 0.79). Independent predictors of mortality were age (odds ratio 1.044, 95% confidence interval 1.014-1.075, p = 0.004), mean pulmonary artery pressure (1.082, 1.026-1.141, p = 0.036), sequential organ failure assessment score (1.148, 1.018-1.294, p = 0.024), and days of mechanical ventilation prior to referral (1.064, 1.008-1.123, p = 0.025). Conclusion: ECMO treatment does not predict mortality in patients with most severe ARDS.