Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure.

BACKGROUND: A group of patients with severe acute respiratory distress syndrome (ARDS) is resistant to advanced respiratory therapy. In these patients, extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy. This study presents 14 years of experience from a Scandinavian ECMO centre. The aim of the study is to present outcome results and to investigate whether or not simplified acute physiology score II (SAPS-II), sequential organ failure assessment (SOFA) and/or Murray scores can be used to predict patients' outcome. METHODS: In a prospective observational study, we collected data from ECMO patients from January 1997 to March 2011. The treatment was based mainly on venous-venous ECMO and centrifugal pumps. Patients were retrieved from Denmark plus a number from Sweden and Norway. The inclusion criteria were the classical criteria until November 2009 (n = 100), after which the new Extracorporeal Life Support Organisation criteria (n = 24) were used. RESULTS: One hundred and twenty-four patients were enrolled with median age 45 (range 16-67) years. The median Murray score was 3.7 (2.5-4.0). One hundred and six (85%) of the patients were retrieved from referring hospitals on ECMO. The median duration of the ECMO runs was 215 (1-578) h. Ninety-seven (78%) of the patients could be weaned from ECMO. A total of 88 (71%) were discharged alive to the referring hospitals. High SAPS-II, SOFA and Murray scores were associated with a high mortality. CONCLUSION: Patients with severe ARDS have a favourable outcome when treated with ECMO and when an ECMO retrieval team establishes the ECMO treatment at the referring hospital. SAPS-II, SOFA and Murray scores predicted the outcome.

Intra-aortic balloon pumping increases renal blood flow in patients with low left ventricular ejection fraction.

Intra-aortic balloon pumping (IABP) has, for decades, been one of the key treatment modalities following impaired cardiac function after cardiac surgery. IABP increases cardiac output, decreases oxygen consumption of the heart and relieves the left ventricle. However, a number of complications have been reported in connection with IABP treatment. Only a few studies have evaluated renal blood flow and the purpose of this prospective study was to evaluate whether renal blood flow was affected by IABP treatment in high-risk patients. After approval from the county ethical committee and informed consent, seven consecutive patients with low left ventricular ejection fraction and scheduled for preoperative IABP treatment were allocated to the study. Assessment of renal blood flow was based on ultrasound spectral Doppler estimation of the flow velocity profiles in the interlobar kidney arteries. The result was described as balloon index (BI), which is maximal systolic velocity divided by the temporal mean velocity. Typical velocity profiles were demonstrated in all patients before, during and after IABP. BI measurement changed with time (p <0.05). BI was lower during IABP compared to both pre-IABP and post-IABP (p <0.025), indicating a higher renal blood flow. No statistically significant changes were seen in s-creatinine or creatinine clearance. Assuming unchanged diameter of kidney arteries and no considerable decrease in renal resistance and/or compliance, we conclude that the interlobar renal blood flow was significantly increased during IABP treatment, measured by ultrasound Doppler technique, but without a simultaneously significant change in creatinine clearance.