Venovenous extracorporeal membrane oxygenation for acute lung failure in adults

BACKGROUND: Acute lung failure (ALF) is an increasing problem that can be treated with veno-venous extracorporeal membrane oxygenation (vv-ECMO). This report summarizes prospectively collected data of an institutional experience with vv-ECMO. METHODS: From January 2007 to December 2010, 176 patients (mean age, 48 +/- 16; range, 14-78 years) with ALF refractory to conventional therapy were supported with vv-ECMO. The general indication for vv-ECMO was a partial oxygen pressure/fraction of inspired oxygen (FIO(2)) < 80 mm Hg under a FIO(2) of 1.0, a positive end-expiratory pressure of 18 cm H(2)O, and refractory respiratory acidosis (pH < 7.25), despite optimization of conservative therapy. RESULTS: All patients underwent peripheral cannulation. In 59 cases, vv-ECMO was placed in another facility with ECMO transport by helicopter or ambulance. The mean vv-ECMO support interval was 12 +/- 9.0 days (range, 1-67 days). During ECMO, 12 patients (7%) could be extubated and stepwise mobilized. Cannula-related complications during long-term support occurred in 14%, which was mostly minor bleeding. Overall survival was 56%: 58 patients (33%) died during mechanical support, and 20 (11%) died after weaning from the system. The best outcome was noted in trauma patients. Risk factors were mainly advanced age and multiorgan failure. CONCLUSION: Modern vv-ECMO is an excellent treatment in patients with severe ALF and should be more liberally used. J Heart Lung Transplant 2012;31:9-15 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.