Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Venovenous Extracorporeal Membrane Oxygenation for Postoperative Acute Respiratory Distress Syndrome

  • Seo, Dong Ju (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Jae Suk (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.09.02
  • Accepted : 2014.10.27
  • Published : 2015.06.05
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has recently attracted interest as a treatment for severe acute respiratory distress syndrome (ARDS). However, the outcomes of this procedure in post-surgical settings have not yet been characterized. In this study, we evaluated the outcomes of ECMO in patients with severe postoperative ARDS. Methods: From January 2007 to December 2012, a total of 69 patients (aged $58.3{\pm}11.5$ years, 23 females) who underwent venovenous ECMO to treat severe postoperative ARDS were reviewed. Of these patients, 22 (31.9%) had undergone cardiothoracic surgery, 32 (46.4%) had undergone liver transplantation, and 15 (21.7%) had undergone other procedures. Results: Thirty-four patients (49.3%) were successfully weaned from ECMO, while the other 35 patients (50.7%) died on ECMO support. Among the 34 patients who were successfully weaned from ECMO, 21 patients (30.4%) eventually died before discharge from the hospital, resulting in 13 hospital survivors (18.8%). Multivariable analysis showed that the duration of pre-ECMO ventilation was a significant independent predictor of death (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.29 to 3.90; p=0.004), whereas the concomitant use of continuous venovenous hemodialysis (CVVHD) was associated with improved survival (OR, 0.55; 95% CI, 0.31 to 0.97; p=0.038). Conclusion: Although the overall survival rate of patients treated with ECMO for postoperative ARDS was unfavorable, ECMO offered an invaluable opportunity for survival to patients who would not have been expected to survive using conventional therapy. CVVHD may be beneficial in improving the outcomes of such patients, whereas a prolonged duration of pre-ECMO ventilator support was associated with poor survival.

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References

  1. Kollef MH, Schuster DP. The acute respiratory distress syndrome. N Engl J Med 1995;332:27-37. https://doi.org/10.1056/NEJM199501053320106
  2. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;138:720-3. https://doi.org/10.1164/ajrccm/138.3.720
  3. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342:1334-49. https://doi.org/10.1056/NEJM200005043421806
  4. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. https://doi.org/10.1016/S0140-6736(09)61069-2
  5. Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 2009;35:2105-14. https://doi.org/10.1007/s00134-009-1661-7
  6. Ware LB. Prognostic determinants of acute respiratory distress syndrome in adults: impact on clinical trial design. Crit Care Med 2005;33(3 Suppl):S217-22. https://doi.org/10.1097/01.CCM.0000155788.39101.7E
  7. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure: on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. https://doi.org/10.1007/BF01709751
  8. Hemmila MR, Rowe SA, Boules TN, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 2004;240:595-605.
  9. Smith AH, Hardison DC, Worden CR, Fleming GM, Taylor MB. Acute renal failure during extracorporeal support in the pediatric cardiac patient. ASAIO J 2009;55:412-6. https://doi.org/10.1097/MAT.0b013e31819ca3d0
  10. Selewski DT, Cornell TT, Blatt NB, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med 2012;40:2694-9. https://doi.org/10.1097/CCM.0b013e318258ff01
  11. Selewski DT, Cornell TT, Lombel RM, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011;37:1166-73. https://doi.org/10.1007/s00134-011-2231-3
  12. Hyde BR, Woodside KJ. Postoperative acute respiratory distress syndrome development in the thoracic surgery patient. Semin Thorac Cardiovasc Surg 2006;18:28-34. https://doi.org/10.1053/j.semtcvs.2005.12.002
  13. Shi J, Chen Q, Yu W, et al. Continuous renal replacement therapy reduces the systemic and pulmonary inflammation induced by venovenous extracorporeal membrane oxygenation in a porcine model. Artif Organs 2014;38:215-23. https://doi.org/10.1111/aor.12154
  14. Heering P, Morgera S, Schmitz FJ, et al. Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration. Intensive Care Med 1997;23:288-96. https://doi.org/10.1007/s001340050330
  15. Journois D, Israel-Biet D, Pouard P, et al. High-volume, zerobalanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology 1996;85:965-76. https://doi.org/10.1097/00000542-199611000-00003

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