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Online ISSN 1827-1596
SMART 2002 Milan, May 29-31, 2002
Frenckner B., Palmér P. *, Lindén V. *
From the Astrid Lindgren Children’s Hospital Karolinska Hospital, Karolinska Institutet Stockholm, Sweden Department of Pediatric Surgery
*Department of ECMO
Background. To evaluate the results of treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal life support (ECLS), minimal sedation and low pressure supported ventilation in adults.
Methods. Design and setting: observational study in a tertiary referral center, Intensive Care Unit, Astrid Lindgren Children’s Hospital at Karolinska Hospital, Stockholm, Sweden. Patients: thirty-eight patients aged 17-61 years (mean 38) with severe ARDS. The Murray score of pulmonary injury averaged 3.5 (3.0-4.0) and the mean PaO2/FiO2 ratio was 47 (31-65). Intervention: the patients were treated with veno-venous or veno-arterial ECLS after failure of conventional respiratory therapy. A standard ECLS circuit with no heparinized surfaces was used. The patients were minimally sedated and received pressure-supported ventilation. High inspiratory pressures were avoided.
Results. 25 of the 38 patients survived (total survival rate 66%) after 2-57 days on ECLS (mean 17). Major surgical procedures were performed in several patients during bypass.
Conclusions. A high survival rate can be obtained in adult patients with severe ARDS using ECLS, minimal sedation and pressure-supported ventilation with low inspiratory pressures. Surgical complications are amenable to surgical treatment during ECLS and bleeding problems can be controlled.