Survival of patients with severe acute respiratory distress syndrome treated without extracorporeal membrane oxygenation

Background Case series have reported favorable outcomes with extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome. However, those patients were generally young, with few comorbid conditions. Objective To characterize the clinical features and survival rates of patients with severe acute respiratory distress syndrome who met criteria for ECMO but were managed without it. Methods Patients who met the study criteria were identified prospectively. Inclusion criteria for ECMO included severe hypoxemia, uncompensated hypercapnia, or elevated end-inspiratory plateau pressures despite low tidal volume ventilation. Predicted survival rates with ECMO were calculated using the Respiratory ECMO Survival Prediction score. Results Of the 46 patients who met the criteria for severe acute respiratory distress syndrome and ECMO consideration, 5 received ECMO and 16 patients had at least 1 contraindication to it. The remaining 25 patients met ECMO criteria but did not receive the treatment. The patients' mean age was 53.5 (SD, 14.3) years; 84% had at least 1 major comorbid condition. The median predicted survival rate with ECMO was 57%. The actual hospital discharge survival rate without ECMO was 56%. Conclusions The general medical intensive care patient population with severe acute respiratory distress syndrome is older and sicker than patients reported in prior case series in which patients were treated with ECMO. In this study, the survival rate without ECMO was similar to predicted survival rates with ECMO.