Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study

Abstract

Prolonged extracorporeal membrane oxygenation (ECMO) was evaluated as a therapy for severe acute respiratory failure (ARF). Adult patients [90] were selected by common criteria of arterial hypoxemia and treated with conventional mechanical ventilation (48 patients) or mechanical ventilation supplemented with partial venoarterial bypass (42 patients). Four patients in each group survived. The majority of patients suffered acute bacterial or viral pneumonia (57%). All 9 patients with pulmonary embolism and 6 patients with postraumatic acute respiratory failure died. The majority of patients died of progressive reduction of transpulmonary gas exchange and decreased compliance due to diffuse pulmonary inflammation, necrosis and fibrosis. ECMO supported respiratory gas exchange but did not increase the probability of long-term survival in patients with severe ARF.