Use of inhaled nitric oxide prognosticates poor survival in severe ARDS with venovenous ECMO: a retrospective analysis

Abstract Background Inhaled nitric oxide (iNO) has not been sufficiently evaluated in adult patients with severe acute respiratory distress syndrome (ARDS) under venovenous extracorporeal membrane oxygenation (VV ECMO) support. Objectives This study aims to assess survival in patients with severe ARDS under VV ECMO with iNO. Methods Of the 657 patients under ECMO, 292 under VV ECMO were evaluated. Outcomes in the iNO group (n = 55) were compared with those of the propensity-matched (based on age, sex, height, and sequential organ failure assessment score at admission) control cohort (55 patients under VV ECMO without iNO). Median survival was analyzed using the Kaplan–Meier method, whereas the hazard ratio for in-hospital mortality with iNO use was analyzed using the proportional hazards model. Results Weaning failure from VV ECMO was higher in the iNO group (69.7% vs. 47.3%, p = 0.0033). Thirty percent of patients responded sufficiently to iNO, showing a lower pulmonary arterial pressure. Survival was lower in the iNO group compared with the control cohort (22 vs. 109 days, p = 0.0222). The length of stay in the intensive care unit (ICU) (23 vs. 33 days, p = 0.0186) and total hospital stay (27 vs. 35 days, p = 0.0085) were shorter with iNO use. Survival was lower and the risk of mortality (hazard ratio, 1.8; 95% CI 1.1–3.0, p = 0.027) was higher in patients with iNO administration. Conclusions Inhaled NO in patients under VV ECMO is a strong predictor of shorter median time of survival and in-house mortality.