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The Massachusetts General Hospital Experience From 1990 to 2008

Deepika Nehra, MD; Allan M. Goldstein, MD; Daniel P. Doody, MD; Daniel P. Ryan, MD; Yuchiao Chang, PhD; Peter T. Masiakos, MD

Arch Surg. 2009;144(5):427-432.

Objective  To determine the efficacy of extracorporeal membrane oxygenation (ECMO) for nonneonatal acute respiratory failure.

Design  Single-institution, retrospective medical record review from February 1990 to March 2008.

Setting  Tertiary care hospital.

Patients  Eighty-one nonneonatal patients (mean age, 23 years; age range, 2 months to 61 years) with acute respiratory failure who had failed maximal ventilator support received ECMO therapy between 1990 and 2008. Patients were grouped into 6 categories based on diagnosis: sepsis (n = 8), bacterial or fungal pneumonia (n = 15), viral pneumonia (n = 9), trauma or burn (n = 10), immunocompromise (n = 15), and other (n = 24).

Main Outcome Measure  Survival to hospital discharge.

Results  Overall survival was 53%. Survival was highest in patients with viral pneumonia (78%), followed by bacterial pneumonia (53%), sepsis syndrome (44%), and immunocompromise (40%). Patients treated following trauma or burns had the lowest survival (33%). The average age was 19 years for survivors as compared with 27 years for nonsurvivors. Survival was lower in patients with multiple organ failure as compared with those with single organ failure (33% vs 60%, respectively), in patients who experienced mechanical ventilation for longer than 10 days prior to the initiation of ECMO as compared with those who received ventilatory support for less than 10 days prior to the initiation of ECMO (31% vs 57%, respectively), and in patients requiring more than 400 hours of ECMO support as compared with those requiring less than 400 hours of ECMO support (42% vs 55%, respectively).

Conclusions  Therapy with ECMO may provide a survival benefit in carefully selected patients with nonneonatal acute respiratory failure who have failed maximal ventilator support. Nonneonatal survival with ECMO therapy is strongly dependent on diagnosis, with the highest survival seen in those with viral or bacterial pneumonia. Older age, multiple organ failure, prolonged ventilation prior to ECMO initiation, and long ECMO runs are associated with decreased survival.

Author Affiliations: Divisions of Pediatric Surgery (Drs Nehra, Goldstein, Doody, Ryan, and Masiakos) and General Medicine (Dr Chang), Massachusetts General Hospital, Boston.

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Extracorporeal Membrane Oxygenation for Nonneonatal Acute Respiratory Failure—Invited Critique
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Arch Surg. 2009;144(5):432.
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