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Respiratory Failure & Mechanical Ventilation

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Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry


Population

Adult patients with acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support. The study analyzed data from the Extracorporeal Life Support Organization registry, encompassing 13,681 patients between January 2012 and December 2022.


Intervention

Prolonged VV ECMO support, defined as support for ≥ 21 days and further subdivided into support for ≥ 50 days and ≥ 120 days.


Comparison

Patients with shorter durations of VV ECMO support (< 21 days).


Outcomes

  • Mortality while on VV ECMO support:

  • Patients supported for ≥ 21 days had a higher mortality rate compared to those supported for < 21 days.

  • 46.5% of patients on prolonged VV ECMO (≥ 21 days) were discharged alive compared to 59.7% of those on shorter support (p < 0.001).

  • Survival to hospital discharge:

  • Among those supported with VV ECMO for ≥ 21 days, duration of support was not significantly associated with mortality (OR, 0.99; 95% CI, 0.98–1.01; p = 0.87 and adjusted OR, 0.99; 95% CI, 0.97–1.02; p = 0.48).

  • For patients supported for ≥ 50 days, similar trends were observed.

  • In patients supported with VV ECMO for ≥ 120 days (n = 113), 46.0% were discharged alive.


Clinical Insights for Intensivists

This study offers significant insights into the utilization and outcomes of prolonged VV ECMO for ARDS patients:

  1. Increased Utilization: The use of prolonged VV ECMO has been on the rise, reflecting its growing importance in managing severe ARDS cases.

  2. Survival Rates: While prolonged VV ECMO (≥ 21 days) is associated with lower survival to hospital discharge compared to shorter support durations, a substantial proportion of these patients (46.5%) can still be discharged alive. This includes patients with extremely prolonged support (≥ 120 days), where 46.0% were discharged alive.

  3. Duration vs. Mortality: The study found that duration of VV ECMO beyond 21 days does not significantly impact mortality rates, suggesting that extending ECMO support can be justified without necessarily increasing the risk of mortality.

  4. Clinical Decision-Making: These findings support the use of prolonged VV ECMO in selected patients, emphasizing the potential for clinical recovery even after extended durations of support. Intensivists should consider individual patient responses and other critical factors when determining the duration of VV ECMO support.

This study underscores the importance of personalized approaches to VV ECMO duration in ARDS management, providing valuable data to guide clinical decisions and improve patient outcomes.

S A
F A
Ibrahim Ameen
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