ECMO can successfully support patients with severe acute respiratory distress syndrome in lieu of mechanical ventilation

Objective—Extracorporeal membrane oxygenation (ECMO) is increasingly used in the management of severe acute respiratory distress syndrome (ARDS). With ECMO, select patients with ARDS can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Published experience with this approach, specifically with attention to a patient’s respiratory drive following cannulation, is limited. Designs—We describe our experience with three consecutive patients with severe ARDS supported with right jugular-femoral configuration of veno-venous (VV)-ECMO without therapeutic anticoagulation as an alternative to lung-protective mechanical ventilation (LP-MV). Outcomes are reported including daily respiratory rate (RR), vital capacities (VC), and follow-up pulmonary function testing. Results—Following cannulation, patients were extubated with 24 hours. With ECMO support, all patients were able to maintain a normal RR and experienced steady improvements in VC. Patients received oral nutrition and ambulated daily. At follow-up, no patients required supplemental oxygen. Conclusions—Our results suggest that VV-ECMO can provide a safe and effective alternative to LP-MV in carefully selected patients. This approach facilitates participation in physical therapy and avoids complications associated with mechanical ventilation. Corresponding author: Ankit Bharat, MD, FACS, Northwestern University Feinberg School of Medicine, Division of Thoracic Surgery, 676 N. St. Clair Street, Suite 650, Chicago, Illinois 60611, Phone: 312-926-7552, Fax: 312-695-3644, abharat@nm.org. *CK and JW contributed equally to this work Copyright form disclosure: Dr. Bharat’s institution received funding from National Institutes of Health (NIH) HL125940 and NIH matching funds by the Thoracic Surgery Foundation. Drs. Bharat, Singer, and Budinger received support for article research from the NIH. Drs. Singer and Budinger’s institutions received funding from the NIH. Dr. Singer’s institution also received funding from the Francis Family Foundation. Dr. Cajigas’ institution received funding from United Therapeutics (research study) and Actelion (research study). The remaining authors have disclosed that they do not have any potential conflicts of interest. HHS Public Access Author manuscript Crit Care Med. Author manuscript; available in PMC 2019 November 01. Published in final edited form as: Crit Care Med. 2018 November ; 46(11): e1070–e1073. doi:10.1097/CCM.0000000000003354. A uhor M anscript