Chiu Li-Chung, Chuang Li-Pang, Leu Shaw-Woei, Lin Yu-Jr, Chang Chee-Jen, Li Hsin-Hsien, Tsai Feng-Chun, Chang Chih-Hao, Hung Chen-Yiu, Lin Shih-Wei, Hu Han-Chung, Huang Chung-Chi, Wu Huang-Pin, Kao Kuo-Chin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Membranes (Basel). 2021 May 26;11(6):393. doi: 10.3390/membranes11060393.
The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group ( = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.
重症急性呼吸窘迫综合征（ARDS）患者的高死亡率促使采取积极的临床干预措施。体外膜肺氧合（ECMO）是一种用于治疗危及生命的低氧血症的挽救疗法。针对重症ARDS患者进行ECMO治疗的随机对照试验存在诸多伦理和方法学问题。因此，ECMO的应用指征、最佳实施时机以及预后的预测风险因素尚未得到充分研究。我们进行了倾向评分匹配，以匹配ARDS发病后48小时接受ECMO支持和未接受ECMO支持的患者，基于临床结局和医院死亡率进行比较。共纳入280例重症ARDS患者，87对匹配对的倾向评分匹配结果显示，ECMO组90天医院死亡率为56.3%，非ECMO组为74.7%（P = 0.028）。亚组分析显示，ARDS病情更严重、气道压力更高或序贯器官衰竭评估评分更高的患者在生存方面倾向于从ECMO治疗中获益。多因素逻辑回归显示，接受ECMO治疗的患者医院死亡率显著低于未接受治疗的患者。我们的研究结果表明，早期启动ECMO（48小时内）可能会增加重症ARDS患者的生存几率。
