ECMO and ARDS

[RRTMedic]

For any of the many ICU folks on here, does anyone have any experience implementing ECMO for patients with severe ARDS in an ICU setting? Obviously, my understanding is that it's typically v-v ECMO unless there's also cardiac failure/ involvement as well, in which it may be va-ECMO.

I'm just curious as to what the average mortality is like with these patients at this stage in the ARDS/ sepsis/ MODS game when dealing with these patients first hand. I know, generally speaking these are very sick individuals, and I also understand that this may be a relatively new treatment for this sort of patient.

Any insight that anyone would love to share, as always, is very much appreciated.

Sorry, I don't have any evidence to present right off the top of my head, but I will say that the mortality for ARDS/MODS in the adult patient receiving ECMO is proportionately much higher than in the pediatric world. It would seem that pediatric patients in general respond much better to ECMO than the adult patient.

I personally believe this is due to timing of care. Having worked in MICU/STICU and in NICU/PICU, I will say that pediatric specialists are much more receptive to moving towards advanced ventilator options much sooner in the disease process than most adult counterparts. I sincerely believe that if these advanced modalities (APRV, HFOV, even ECMO) were utilized much sooner in the care of these patients (the adult ones), there might be a change in outcome.

It does seem--again, anecdotal--that adult ASTHMATICS respond well to ECMO. Asthmatics that are not ventilating/not oxygenating on the vent...

ARDS patients are SICK. Their lungs are shot. If they're on ECMO, it's a last-ditch survival/salvage procedure. I believe there are better ways to treat ARDS in general, but poorly set up studies such as OSCAR vs OSCILLATE have seemed to dampen the voices of RTs who have seen HFOV and APRV save lives. I love ECMO, but ECMO isn't the only thing. If anything, these advanced modalities should be implemented sooner and not as a rescue device.

 

[VentMonkey]

I'm digging your posts thus far, but could you please stop bolding them? It hurts my aging eyes.

 

[RRTMedic]

I'm digging your posts thus far, but could you please stop bolding them? It hurts my aging eyes.

No problem... Check out a more detailed discussion of ECMO in Adults attached... Love this journal (for obvious reasons)

 

[VentMonkey]

Cool, thanks. Yeah, I think realistically the majority of the adult ARDS candidates are so sick that regardless of the cause, their morbidity, and/ or mortality is quite low. It's just one of the many topics I geek out on.