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Is There a Preinterventional Mechanical Ventilation Time Limit for Candidates of Adult Respiratory Extracorporeal Membrane Oxygenation

Wu, Meng-Yu*; Huang, Chung-Chi; Wu, Tzu-I‡§; Chang, Yu-Sheng*; Wang, Chin-Liang; Lin, Pyng-Jing*

doi: 10.1097/MAT.0000000000000577

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a useful life support in severe acute respiratory distress syndrome (ARDS). Although prolonged mechanical ventilation (MV) before institution of ECMO is known to be a poor prognostic factor for outcomes of VV-ECMO, a reasonable deadline for this period has not been defined yet. To discover the answer, we reviewed a 9 year institutional experience of adult respiratory ECMO in VV configuration and investigate the relationship between the MV time before ECMO and in-hospital mortality. This retrospective study included 129 adult patients receiving VV-ECMO for ARDS in a single institution from 2007 to 2016. Important demographic and clinical data before ECMO intervention were collected for analyses of in-hospital mortality. The MV time before ECMO independently predicted hospital death in adult respiratory ECMO here. While compared to the patients receiving MV for 7 days or less, the patients receiving MV for more than 7 days before ECMO showed a higher in-hospital mortality rate (77% vs. 38%, p < 0.001). They also experienced a more significant deterioration in respiratory function during MV before the institution of ECMO. Therefore, from the clinical observation, we thought that a 7 day period might be an acceptable limit on MV time before institution of VV-ECMO. Integrating other respiratory parameters into the current PaO2/FiO2 (PF) ratio-based inclusion criteria of adult respiratory ECMO might be helpful to reduce the risk of prolonged MV in selected patients.

From the *Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; and §Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Submitted for consideration October 2016; accepted for publication in revised form March 2017.

Meng-Yu Wu contributed to conception and design of the study, interpretation of the data, and drafted the manuscript. Chung-Chi Huang and Pyng-Jing Lin contributed to the literature review and the formation of therapeutic protocol. Chin-Liang Wang and Yu-Sheng Chang contributed to acquisition and interpretation of the data; Tzu-I Wu performed statistical analysis. Meng-Yu Wu also contributed to manuscript composition and was responsible for the final product. All authors read and approved the final manuscript.

Disclosure: The author declare that they have no conflict of interest.

Correspondence: Meng-Yu Wu, Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linko branch, 5, Fushing Street, Gueishan Shiang, Taoyuan, Taiwan 333, Republic of China. Email:

Copyright © 2017 by the American Society for Artificial Internal Organs