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VOLUME 25 , ISSUE 11 ( November, 2021 ) > List of Articles

Original Article

Practice Patterns and Outcome of Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome in Indian ICUs

Ramadevi Mariappan, Madhan Kumar, Nagarajan Ramakrishnan, Ashwin K Mani, Senthil Kumar, C Vignesh

Keywords : Acute respiratory distress syndrome, Complications, Extracorporeal membrane oxygenation, Indications, Outcomes, Rescue therapy

Citation Information : Mariappan R, Kumar M, Ramakrishnan N, Mani AK, Kumar S, Vignesh C. Practice Patterns and Outcome of Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome in Indian ICUs. Indian J Crit Care Med 2021; 25 (11):1263-1268.

DOI: 10.5005/jp-journals-10071-23928

License: CC BY-NC 4.0

Published Online: 16-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used in managing patients with severe acute respiratory distress syndrome (ARDS). The aim of the study is to describe the practice of ECMO and evaluate the outcomes in patients with severe ARDS in Indian intensive care units (ICUs). Methods: Data of 39 patients with severe ARDS managed with ECMO in two tertiary centers between 2012 and 2018 were retrospectively studied. Results: The mean age of the patient was 44.6 ± 13.5 years and 51% were female. Primary ARDS due to viral pneumonia was the common indication for ECMO. Mean APACHE II and Murray scores were 32.3 ± 7.8 and 3.64 ± 0.21, respectively. Prone ventilation and/or inhaled nitric oxide were used in 69.3% of the patients prior to ECMO therapy. Among 39 patients, 38 patients were managed with venovenous ECMO and 1 patient was managed with venoarterial ECMO. Average ECMO duration was 9.4 ± 6.9 days. Among the 17 (43.5%) patients successfully weaned off ECMO, 15 (38.5%) survived to discharge home. The average ICU and hospital length of stay were 18.9 ± 15.5 and 20.6 ± 16.6 days, respectively. While, sepsis was the common complication noted in 19 (49%) patients, bleeding and thrombotic complications were also noted in six and two patients, respectively. Conclusion: In conclusion, ECMO support was used as rescue therapy in severe ARDS with a survival rate of 39%. Sepsis was the common complication of ECMO followed by bleeding and thrombosis.


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  1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307(23):2526–2533. DOI: 10.1001/jama.2012.5669.
  2. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342(18):1301–1308. DOI: 10.1056/NEJM200005043421801.
  3. Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159–2168. DOI: 10.1056/NEJMoa1214103.
  4. Papazian L, Forel J-M, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010;363(12):1107–1116. DOI: 10.1056/NEJMoa1005372.
  5. Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, et al. Randomized, placebo-controlled clinical trial of an aerosolized beta-2 agonist for treatment of acute lung injury. Am J Respir Crit Care Med 2011;184(5):561–568. DOI: 10.1164/rccm.201012-2090OC.
  6. Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest 2005;128(2):525–532. DOI: 10.1378/chest.128.2.525.
  7. Gattinoni L, Carlesso E, Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care 2011;15(6):243. DOI: 10.1186/cc10490.
  8. Grasselli G, Foti G, Patroniti N, Giuffrida A, Cortinovis B, Zanella A, et al. A case of ARDS associated with influenza A - H1N1 infection treated with extracorporeal respiratory support. Minerva Anestesiol 2009;75(12):741–745. PMID 19940827.
  9. Kao TM, Wang CH, Chen YC, Ko WJ, Chang SC. The first case of severe novel H1N1 influenza successfully rescued by extracorporeal membrane oxygenation in Taiwan. J Formos Med Assoc 2009;108(11):894–898. DOI: 10.1016/S0929-6646(09)60422-8.
  10. Davies A, Jones D, Gattas D, for the ANZ-ECMO Investigators. Extracorporeal membrane oxygenation for ARDS due to 2009 influenza A (H1N1) [reply]. JAMA 2010;303(10):942. DOI : 10.1001/JAMA.2010.202.
  11. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009; 302(17):1888–1895. DOI: 10.1001/jama.2009.1535.
  12. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374(9698):1351–1363. DOI: 10.1016/S0140-6736(09)61069-2.
  13. Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018;378:1965–1975. DOI: 10.1056/NEJMoa1800385.
  14. Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr. Weaver LK, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994;149(2 Pt 1):295–305. DOI: 10.1164/ajrccm.149.2.8306022.
  15. Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. Jama 1979; 242(20):2193–2196. DOI: 10.1001/jama.242.20.2193.
  16. Makdisi G, Wang IW. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 2015;7(7):E166–E176. DOI: 10.3978/j.issn.2072-1439.2015.07.17.
  17. Liu X, Xu Y, Zhang R, Huang Y, He W, Sang L, et al. Survival predictors for severe ARDS patients treated with extracorporeal membrane oxygenation: a retrospective study in China. PLoS One 2016;11(6):e0158061. DOI: 10.1371/ journal. pone.015806.
  18. Poobani S, Goyal V, Oza P, Kapoor PM. ECMO challenges and its future: Indian Scenerio. J Cardiac Crit Care TSS 2017;01(02):89–94. DOI: 10.1055/s-0038-1626672.
  19. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, et al. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 1998;158(4):1076–1081. DOI: 10.1164/ajrccm.158.4.9802009.
  20. Suntharalingam G, Regan K, Keogh BF, Morgan CJ, Evans TW. Influence of direct and indirect etiology on acute outcome and 6-month functional recovery in acute respiratory distress syndrome. Crit Care Med 2001;29(3):562–566. DOI: 10.1097/00003246-200103000-00016.
  21. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest 2006;130(3):724–729. DOI: 10.1378/chest.130.3.724.
  22. Bizzarro MJ, Conrad SA, Kaufman DA, Rycus P, Extracorporeal Life Support Organization Task Force on Infections, Extracorporeal Membrane Oxygenation. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. PediatrCrit Care Med 2011; 12:277–281. DOI: 10.1097/PCC.0b013e3181e28894.
  23. Schmidt M, Bréchot N, Hariri S, Guiguet M, Luyt C-E, Makri R, et al. Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 2012;55(12):1633–1641. DOI: 10.1093/cid/cis783.
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