Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure
A Randomized Prospective Study
- Warren M. Zapol, MD;
- Michael T. Snider, MD, PhD;
- J. Donald Hill, MD;
- Robert J. Fallat, MD;
- Robert H. Bartlett, MD;
- L. Henry Edmunds, MD;
- Alan H. Morris, MD;
- E. Converse Peirce II, MD;
- Arthur N. Thomas, MD;
- Herbert J. Proctor, MD;
- Philip A. Drinker, PhD;
- Philip C. Pratt, MD;
- Anna Bagniewski, MA;
- Rupert G. Miller Jr, PhD
- From the Department of Anesthesia, Massachusetts General Hospital, Boston (Drs Zapol and Snider); Departments of Surgery (Dr Hill) and Medicine (Dr Fallat), Pacific Medical Center, San Francisco; Department of Surgery, Orange County Medical Center, Orange, Calif (Dr Bartlett); Department of Surgery, University of Pennsylvania, Philadelphia (Dr Edmunds); Department of Pulmonary Medicine, LDS Hospital, Salt Lake City (Dr Morris); Department of Surgery, Mount Sinai Hospital, New York (Dr Peirce); Department of Surgery, San Francisco General Hospital (Dr Thomas); Department of Surgery, University of North Carolina, Chapel Hill (Dr Proctor); Division of Bioengineering, Peter Bent Brigham Hospital, Boston (Dr Drinker); Department of Pathology, Duke University Medical Center, Durham, NC (Dr Pratt); ECMO Data Center, Institutes of Medical Sciences, San Francisco (Ms Bagniewski); and Department of Statistics, Stanford (Calif) University (Dr Miller).
Abstract
Nine medical centers collaborated in a prospective randomized study to evaluate prolonged extracorporeal membrane oxygenation (ECMO) as a therapy for severe acute respiratory failure (ARF). Ninety adult patients were selected by common criteria of arterial hypoxemia and treated with either conventional mechanical ventilation (48 patients) or mechanical ventilation supplemented with partial venoarterial bypass (42 patients). Four patients in each group survived. The majority of patients suffered acute bacterial or viral pneumonia (57%). All nine patients with pulmonary embolism and six patients with posttraumatic acute respiratory failure died. The majority of patients died of progressive reduction of transpulmonary gas exchange and decreased compliance due to diffuse pulmonary inflammation, necrosis, and fibrosis. We conclude that ECMO can support respiratory gas exchange but did not increase the probability of long-term survival in patients with severe ARF.
(JAMA 242:2193-2196, 1979)
Footnotes
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Reprint requests to Department of Anesthesia, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Zapol).
