Yeo HJ, et al. - This study provides an insight into the benefits and potential complications of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA). Data from the Extracorporeal Life Support Organization (ELSO) Registry was analyzed and it was found that in addition to providing adequate gas exchange and preventing lung injury induced by mechanical ventilation, ECMO may serve as an effective bridging strategy to avoid aggressive ventilation in refractory NFA. However, for abating complications, careful management was needed.

Methods

• This study included cases extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016.
• Researchers also extracted all patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO.
• Patients who underwent multiple courses of ECMO; those who received ECMO for cardiopulmonary resuscitation or cardiac dysfunction; and those with another primary diagnosis, such as sepsis were excluded.
• An analysis was also performed of survival to hospital discharge, complications, and clinical factors associated with in-hospital mortality, in patients with severe life-threatening NFA requiring ECMO support.

Results

• This study included 272 patients.
• According to data, the mean time spent on ECMO was 176.4 hours.
• After ECMO initiation, significant improvements were evident in ventilator settings, including rate, fraction of inspired oxygen (FiO₂), peak inspiratory pressure (PIP), and mean airway pressure (rate (breaths/min), 19.0 vs 11.3, p < 0.001; FiO₂ (%), 81.2 vs. 48.8, p < 0.001; PIP (cmH₂O), 38.2 vs. 25.0, p < 0.001; mean airway pressure (cmH₂O): 21.4 vs. 14.2, p < 0.001).
• After ECMO support, driving pressure was significantly decreased, in particular (29.5 vs. 16.8 cmH₂O, p < 0.001).
• As per findings, the weaning success rate was 86.7%, and the rate of survival to hospital discharge was 83.5%.
• The reported total complication rate was 65.1% and the most commonly documented complications were hemorrhagic complications (28.3%), the other being renal (26.8%), cardiovascular (26.1%), mechanical (24.6%), metabolic (22.4%), infection (16.5%), neurologic (4.8%), and limb ischemia (2.6%).
• Data revealed that cannulation site hemorrhage was most common (13.6%) of the hemorrhagic complications.
• On multivariate logistic regression, researchers found that hemorrhage was related to increased in-hospital mortality (odds ratio, 2.97; 95% confidence interval, 1.07–8.24; p=0.036).
• In addition, occurrence of hemorrhage-induced death was reported in 4 patients (1.5%) and organ failure (37.8%) was documented as the most common reason for death.