328 ASAIO Journal 2013 Legionella-associated respiratory failure has a high mortality, despite modern ventilation modalities. Extracorporeal mem- brane oxygenation (ECMO) is used to achieve gas exchange independent of pulmonary function in patients with severe respiratory failure. This was a retrospective review of the man- agement and outcome of patients with Legionella-associated respiratory failure treated with ECMO support in a large ECMO center over the past 10 years. A retrospective review of patients with confirmed Legionella-associated severe respiratory fail- ure managed with ECMO support at a single center. Between 2000 and 2010, 19 patients with severe respiratory failure caused by Legionella were managed with ECMO after failure to respond to conventional intensive care management. Median PaO 2 /FiO 2 ratio was 66 and median pCO 2 was 60 torr. Sixteen patients (84%) survived to hospital discharge. Extracorporeal membrane oxygenation should be considered in patients with Legionella-associated respiratory failure, who have failed con- ventional ventilation. ASAIO Journal 2013;59:328–330. Key Words: extracorporeal membrane oxygenation, Legion- naire’s disease, severe respiratory failure, Legionella Acute respiratory failure secondary to Legionella carries a significant morbidity and mortality, which has varied little in England and Wales since 1980, 1 despite the introduction of urine antigen testing and improved antimicrobial therapy dur- ing this period. 2,3 Mortality reported by the Health Protection Agency for England and Wales in 2009 was 12.5% compared with 13% in 1980. Some authors have reported the mortality for patients with Legionnaire’s disease requiring intensive care management as 30% 4 and 33%. 5 Lung protective ventilation is the standard for patients with acute respiratory failure requiring mechanical ventilation. High-frequency oscillatory ventilation (HFOV) and prone posi- tioning are optional adjunctive therapies. Despite these man- agement strategies, a small subset of patients exists in whom adequate oxygenation or carbon dioxide removal cannot be achieved. Extracorporeal membrane oxygenation (ECMO) has been shown to improve outcome for adults who have failed conventional management. 6,7 By routing the patient’s blood through an extracorporeal circuit with an incorporated oxy- genator, gas exchange is not solely dependent on the lungs, permitting lung protective ventilation. The Heartlink ECMO Centre at Leicester has been provid- ing ECMO support since 1989. In 1999, a report from this center on confirmed or probable Legionella pneumonia man- aged with ECMO support showed a survival of 53.8%. 8 The conduct of ECMO, mode of cannulation, and type of circuit have since evolved. We hereby review the management and outcome of patients with Legionella pneumonia managed with ECMO support at the same ECMO center over the past 10 years. Methods Study Design, Setting, and Participants A retrospective review at a single ECMO center of patients with confirmed Legionella-associated acute respiratory failure man- aged with ECMO support. Study period ranged from October 2000 to September 2010. Inclusion criteria were age >18 years, primary diagnosis of confirmed Legionella, and management with ECMO support. Patients who were managed conventionally at the Heartlink ECMO Centre were excluded from this report. Data Sources Patients were identified from the locally held ECMO database. Search fields included Legionella as the primary diagnosis both at referral to ECMO and at discharge from ECMO. Information was obtained from the case notes, referral sheets, extracorporeal life support organization forms, and discharge summaries of the patients identified. The case notes of three patients had been destroyed, but adequate information could be obtained on the patients from the other sources to allow inclusion in this review. Variables To define clinical status before ECMO, we documented demographics (age, weight, and sex), date of intubation, use Case Series Extracorporeal Membrane Oxygenation and Severe Acute Respiratory Distress Secondary to Legionella: 10 Year Experience MORONKE A. NOAH, GEETHANJALI RAMACHANDRA, MARGARET M. HICKEY, DAVID R. JENKINS, CHRIS J. HARVEY, CLAIRE A. WESTROPE, RICHARD K. FIRMIN, AND GILES J. PEEK Copyright © 2013 by the American Society for Artificial Internal Organs DOI: 10.1097/MAT.0b013e31829119c6 From the Heartlink ECMO Centre, University Hospitals of Leicester NHS Trust, Leicester, UK. Submitted for consideration June 2012; accepted for publication in revised form February 2013. Disclosure: The authors have no conflicts of interest to report. Reprint Requests: Moronke A. Noah, Department of Anaesthetics, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK. Email: abinoah@doctors. org.uk.