Survival of Patients With Severe Acute Respiratory Distress Syndrome Treated Without Extracorporeal Membrane Oxygenation.
Sarina K Sahetya, Roy G Brower, R Scott Stephens
PMID 29716909WHAT IT FOUND
In 25 severe ARDS patients eligible for ECMO but treated without it, survival was 56%, close to the 57% predicted if ECMO had been used.
This observational study does not show ECMO is unnecessary.
Key findings
01Among the 25 patients who met ECMO criteria but did not receive ECMO, survival to hospital discharge was 56%, compared with a predicted survival of 57% if ECMO had been used.
02Sixteen of the 41 patients treated without ECMO had at least one ECMO contraindication, and 25% of that subgroup survived to hospital discharge.
03Five patients received rescue ECMO, and 20% of them survived to hospital discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center observational study of only 46 patients, so it cannot show that ECMO and usual care have the same effect. Patients were not randomly assigned to receive ECMO or not, and the 5 patients who received ECMO were younger but had worse gas exchange and respiratory mechanics, so they are not a fair comparison. The Respiratory ECMO Survival Prediction score was developed for patients who received ECMO and has not been validated for patients who did not receive ECMO. Most prior ECMO case series were in H1N1 influenza patients, who were generally younger and had fewer comorbidities than this cohort. Only 48% received neuromuscular blockade and 12% were prone, so the study does not show what outcomes would be with fuller use of these adjuncts.
The easy way to misread this
Do not conclude that ECMO is unnecessary or that usual care is equivalent. This was an observational study without randomization. The 56% survival in eligible patients not receiving ECMO was compared with a predicted 57% from a score developed for patients who did receive ECMO.