Extracorporeal Membrane Oxygenation for Adult Respiratory Failure* Giles J. Peek, MBBS; Hilliary M. Moore, RGN; Nick Moore, MBBS; Andrezj W. Sosnowski, MD; and Richard K. Firmin, MBBS Objectives: To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. Design: Retrospective chart review. Setting: Extracorporeal Life Support Organization/European Extracorporeal Life Support Orga- nization recognized ECMO center. Patients: Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995. Interventions: None. Measurements and results: Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO 2 to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressure, 39.6 (7.4) cm H 2 O; end-expiratory pressure, 10 (3.3) cm H 2 O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p0.036 and p0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p0.036). Conclusions: Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation. (CHEST 1997; 112:759-64) Key words: ARDS; ECMO; survival Abbreviations: ECMO=extracorporeal membrane oxygenation; FIo 2 =fraction of inspired oxygen; PaO 2 /FIo 2 =ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen; PCIRV=pressure control inverse ratio ventilation T he survival of adult patients with acute severe respiratory failure is 40% 1 and has changed little in recent years. 2,3 Pressure-controlled inverse ratio ventilation can result in better survival than historical series, 4 but there is only 45% survival overall. Permissive hypercapnia may also improve outcome. 5,6 Extracorporeal gas exchange has been proved to result in improved survival in severe neonatal respiratory failure, 7 and is theoretically an attractive idea, as it allows reduction of ventilator settings to reduce barotrauma and oxygen toxicity. Randomized studies of extracorporeal gas exchange in adults have not shown improved outcome 8,9 de- spite the reporting of several series 10-12 showing survival figures in excess of those quoted in series of conventionally treated patients. 1-3 We describe the first 50 adult patients to receive extracorporeal mem- brane oxygenation (ECMO) in our hospital. Materials and Methods Setting Our adult, pediatric, and neonatal ECMO program is recog- nized by the Extracorporeal Life Support Organization and the European Extracorporeal Life Support Organization. The pro- gram operates in the cardiac and pediatric ICUs of a cardiotho- racic surgical department. The program is staffed by cardiotho- racic surgeons, anesthesiologists, pediatricians, perfusionists, and nurses with specific training in ECMO. Patients are referred from hospitals all around the United Kingdom at the discretion of their consultants. A total of 299 patients of all ages have been treated between the start of the program in 1989 and the end of June 1996. *From the Heartlink ECMO Centre, Department of Cardiotho- racic Surgery, Glenfield Hospital, Leicester, UK. Heartlink ECMO Centre receives support from Heartlink Chil- dren’s Charity. Dr. Peek is the holder of a British Heart Foundation, Junior Research Fellowship. Manuscript received November 11, 1996; revision accepted February 14, 1997. CHEST / 112 / 3 / SEPTEMBER, 1997 759