Eastern Cardiothoracic Surgical Society

Contemporary Outcomes of Adult Veno Venous ECMO for ARDS
Karthik Mikkineni, Robert J. Moraca, Allegheny General Hospital, Pittsburgh, PA


OBJECTIVE: Despite advances in critical care medicine, ARDS is associated with high mortality rates. The final rescue for patients who fail to maintain adequate oxygenation rates with conventional ventilator management is Extra Corporeal Membrane Oxygenation (ECMO). The current report reviews our experience with adult Veno-Venous ECMO for acute respiratory failure from various reasons which failed to improve with conservative ventilatory management.

METHODS: Retrospective clinical review of single center experience with adult V-V ECMO for Acute Respiratory failure from 2009-2014, its outcomes and complications.

RESULTS: In 2009, 7 patients were placed on V-V ECMO and 3 survived with average ECMO time of 18 days. These were when referrals for ECMO were made after prolonged periods of failed conservative managements. In 2010, 7 patients were placed on ECMO and 4 survived with average ECMO time of 4 days. In 2011, out of 9 patients placed on ECMO, 4 survived. Early referrals for ECMO started in 2012. In 2012 out of 14 patients placed on ECMO 11 survived with average ECMO time being 9 days. In 2013 16 patients were placed on ECMO and 9 survived with average ECMO time of 10 days. In 2014 so far we had 14 cases of adult V-VECMO out of which 8 patients survived. Overall, major complications included Neurologic (stroke), hemorrhagic(DIC), Renal failure, vascular (Fasciotomy, Amputation), Cardiopulmonary (brady arrest, pulmonary hemorrhage).

CONCLUSIONS: V-V ECMO is a life saving treatment for ARDS and early referral to experienced ECMO centers may have improved outcomes.

Contemporary outcomes of Adult V-V ECMO

Year No. of
patients
placed
on ECMO
No. of
Survivors
Indications Complications Average
time on
ECMO
Among
survivors
2009 7 3 Trauma/ARDS/H1N1 Hemorrhage(DIC), Renal,
Brady arrest, Pulmonary Hemorrhage
18 days
2010 7 4 ARDS/COPD Hemorrhagic stroke, Renal Failure, Brady
Arrest
4 days
2011 9 4 ARDS, Pneumonia,Pulmonary
Embolism
Renal, Neurologic,
Hemorrhage (DIC)
5 days
2012 14 11 Trauma/ARDS/
Respiratory failure
s/p endocarditis, AVR, MVR,
aspiration
Neurologic, Renal failure, Amputation 9 days
2013 16 9 Pneumonia, Pulmonary fibrosis,
ARDS, Trauma, H1N1
Renal failure, GI bleed, DIC 10 days
2014 14 8 H1N1, ARDS, Trauma, s/p TAVR,
VSD repair, pulmonary
embolectomy
Hemorrhagic, Renal failure. 12 days