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EMPROVING outcomes: Evaluating the effect of an ultralung protective strategy for patients with ARDS treated with ECMO
Author(s) -
Grant April A.,
Badiye Amit,
Mehta Christina,
Wu Ziyue,
Koerner Michael,
Vianna Rodrigo,
Loebe Matthias,
Ghodsizad Ali
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14923
Subject(s) - medicine , ards , extracorporeal membrane oxygenation , odds ratio , confidence interval , retrospective cohort study , acute respiratory distress , anesthesia , respiratory failure , lung , surgery
Objective Since the initiation of an adult extracorporeal membrane oxygenation (ECMO) program at our institution, the program has managed well over 200 patients with ECMO in a 3‐year time frame. While there is a plethora of research evaluating ECMO for acute respiratory distress syndrome (ARDS), few studies have evaluated the impact that ventilator management after cannulation might have on outcomes. We hypothesized that failure to properly protect the lungs after cannulation would lead to higher mortality. Materials and Methods This was a retrospective observational study performed from 1 January 2014 to 8 July 2018. Results A total of 196 patients were treated with ECMO, 57 of whom were diagnosed with ARDS and treated with venovenous ECMO. The univariable analysis revealed a statistically higher total serum bilirubin and lower total days on ECMO in those who died vs those who lived. During ECMO, higher mean peak inspiratory pressures (PIP) and higher FiO 2 were found in those who died vs those who lived. In multivariable analysis, increasing age (odds ratio [OR] = 1.2; confidence interval [CI] = 1.04‐1.39, P = .02), increasing mean PIP, and increasing mean FiO 2 concentration during ECMO (PIP: OR = 1.40, CI = 1.03‐1.89, P = .03; FiO 2 : OR = 1.16, CI = 1.02‐1.32, P = .02) were all associated with increased mortality. Conclusion Failing to protect the lungs with a lung protective strategy such as the EMPROVE protocol after ECMO cannulation was associated with mortality. For every 1 mm Hg increase in the mean PIP, the odds of dying increased 1.4 times, and for every 1% increase in the mean FiO 2 , the odds of dying increased 1.16 times. For lung rest to truly be effective, the lungs must be relieved of the burden of gas exchange.