To examine, by retrospective analysis, the use and outcome of extracorporeal life support in adults with severe respiratory failure and moribund sepsis.
Measurements included ventilatory support parameters and systemic PaO2/FiO2 ratio before extracorporeal life support (ECLS), time on ECLS, number of ventilator days, number of intensive care unit days, number of hospital days, associated extracorporeal membrane oxygenation (ECMO) complications, transfusion need, and survival.
Eight patients between 22 and 45 years of age with severe respiratory failure and moribund sepsis were selected for ECLS as a salvage maneuver. Each patient was objectively in extremis and pending emminent demise as evidenced by multiorgan failure, refractory hypotension,refractory hypoxia, and the inability to provide adequate oxygen delivery. If the patient had no absolute contraindications, such as acute brain hemorrhage, then venoarterial or venovenous ECLS was employed. All patients required continuous venovenous hemodialysis prior to ECLS. Prior to initiating ECLS all patients were on the ventilator for at least 12 hours with oxygen saturations of <80% despite FiO2 at 1.0,and PEEP >19cm water. Multiple pressors were needed to barely maintain a mean arterial pressure >55mmHg. Low tidal volume and high frequency techniques were applied in all patients before ECLS and very low tidal volumes of 3cc/Kg were utilized during ECLS. Two of the 8 failed prone positioning maneuvers prior to ECLS. Six patients survived to decanulation. Two patients expired within 12 hours of starting ECLS. Six are alive, with follow-up times ranging from 1 to 7 yrs.
ECLS may be a life-sustaining supportive therapy that enables a reasonable increase in survivability in a relatively young population who otherwise would have a 100% mortality.
ECLS, usually reserved for infants and occasionally adults with lung limitted disease, could potentially have an increased survivability when employed to those with multiorgan failure from moribund sepsis. Unfortunately, because of high expense and the limited number of facilities experienced in adult ECLS, a prospective randomized trial is not likely to take place.
M. Zgoda, None.