The Proper Time Of The Treatment Of Patients With Severe Acute Respiratory Distress Syndrome By Extracorporeal Membrane Oxygenation

ObjectiveThe aim of the study was to evaluate the proper time of the treatment of patients with severe acute respiratory distress syndrome（ARDS）by extracorporeal membrane oxygenation（ECMO）.This retrospective cohort study was conducted from February2016 to February 2018 at the first affiliated Hospital of Zhengzhou University.MethodTo collect the patients with ARDS who received Veno-Venous ECMO support therapy in the first affiliated Hospital of Zhengzhou University from February 2016 to February 2018.The clinical data included age,gender,diagnosis,and mean temperature,respiratory rate,heart rate,and the PH,PaO₂,PaCO₂,potassium concentration,sodium concentration,lactate concentration and blood sugar level in the arterial blood gas analysis;Oxygenation index,leukocyte count,neutrophil count,lymphocyte count,platelet count,ratio of neutrophil to lymphocyte,and levels of hemoglobin,albumin,bilirubin,alanine aminotransferase（ALT）,creatinine,procalcitonin,C-reactive protein,proBNP,and the PEEP,pressure and the time of ventilator using,the APACHE II scores,the chest radiography score before 24 hours of the working of ECMO,and the incidence of complications after ECMO application.According to the survival and discharge from the hospital,the patients were divided into hospital death group and survival group.Multivariate Logistic regression analysis was used to analyze the independent risk factors of hospital death in patients with ARDS.The prognostic value of risk factors was evaluated by the receiver operating characteristic curve.ResultsA total of 56 patients with severe ARDS patients received V-V ECMO support therapy,included 22 females and 34 males,all of whom were V-V ECMO.Among them,25 patients were successfully discharged from ECMO,and bleeding was the most common complication.All of the three patients with pulmonary hemorrhage were died.The univariate Logistic regression analysis showed that the mean age（OR=4.019,95%CI:1.001-1.085,P=0.045）,The average body temperature（OR=4.642,95%CI:1.104-8.079,P=0.031）,the respiratory rate（OR=34.062,95%CI:1.130-1.279,P<0.001）,the heart rate（OR=6.079,95%CI:1.008-1.069,P=0.014）,and PaO2（OR=4.040,95%CI:0.902-0.999,P=0.044）,blood lactate concentration（OR=35.754,95%CI:6.640-42.068,P<0.001）,Oxygenation index（OR=33.828,95%CI:0.716-0.847,P<0.001）,albumin concentration（OR=5.497,95%CI:0.730-0.972,P=0.019）and APACHEII score（OR=22.195,95%CI:1.084-1.215,P<0.001）and the chest radiography score（OR=41.637,95%CI:5.364-23.227,P<0.001）as the risk factors associated with hospital mortality in patients with ECMO.The multivariate Logistic regression analysis showed that the respiratory rate（OR=7.251,95%CI:1.127-2.131,P<0.001）,the oxygenation index（OR=12.611,95%CI:0.559-0.845,P<0.001）,and the blood lactate concentration（OR=8.386,95%CI:3.061-331.936,P<0.001）,APACHE II score（OR=4.235,95%CI:1.007-1.334,P<0.001）,and the chest radiography score（OR=7.658,95%CI:1.700-22.390,P<0.001）as the independent risk factors for hospital mortality in patients with ECMO.The receiver operating characteristic curve showed that the Area Under Curve of the respiratory rate is 0.808（95%CI:0.740-0.876）and the cut-off point is 22.50（Sensitivity 83.30%;Specificity 68.40%;Youden index 0.517）,the Area Under Curve of the oxygenation index is 0.956（95%CI:0.931-0.982）and the cut-off point is 58.15（Sensitivity 94.70%;Specificity 87.50%;Youden index 0.822）,the Area Under Curve of the blood lactate concentration is 0.887（95%CI:0.841-0.934）and cut-off point is2.50（Sensitivity 70.80%;Specificity 94.70%;Youden index 0.655）,the Area Under Curve of APACHE II score is 0.749（95%CI:0.666-0.832）and cut-off point is 15.50（Sensitivity 91.70%;Specificity 57.90%;Youden index 0.496）,the Area Under Curve of the chest radiography score is 0.840（95%CI:0.776-0.904）and cut-off point is 3.50（Sensitivity 41.70%;Specificity 89.40%;Youden index 0.312）.ConclusionThe V-V ECMO model was used to treatment the patients with severe ARDS when the traditional treatment was failure.The indications and contraindications should be strictly grasped.The effects of ECMO were significantly,respiratory rate,oxygenation index,blood lactate concentration,APACHE II score and the chest radiography score were independent risk factors for hospital death in patients with ECMO and their predictive value was high.oxygenation index=58.15mmHg,blood lactate concentration=2.50mm/L,the chest radiography score=3.50,respiratory rate=22.50,and APACHE II score=15.50 were the cut-off value of the application of the V-V ECMO,the treatment of the patients with severe ARDS by the V-V ECMO may reduce the mortality before the above indexes were significantly worse;Bleeding was the main complication of ECMO application in which pulmonary hemorrhage was fatal.