Early experience with adult extracorporeal membrane oxygenation in the modern era

In 1980 we stopped using extracorporeal membrane oxygenation for adults because only 1 of 20 patients treated between 1973 and 1979 survived. In October 1988 we returned to adult extracorporeal life support (ECLS) with a modified protocol including venovenous access when possible, large oxygenators for CO2 clearance, activated clotting time of 180 to 200 seconds, and case selection based on 90% mortality (30% transpulmonary shunt). Of 19 patients referred, 14 met criteria for ECLS. Three of these 14 patients with isolated respiratory failure died before ECLS could be started, and 1 patient refused ECLS and died. Ten were placed on ECLS for 2 to 24 days. Indications were pneumonia (3), post-cardiac operation (2), and adult respiratory distress syndrome (5). Five recovered and 5 died. The cause of early death was progressive pulmonary injury (3), hemorrhage (1), and ventricular arrhythmia (1). One late death occurred at 3 months secondary to intraabdominal complications related to liver transplantation. In conclusion, 10 adult patients with severe respiratory failure were treated with extracorporeal life support; 5 patients recovered lung function and 4 of these patients survived and were discharged to home. Surviving patients were typically younger and were placed on ECLS early in their disease process, emphasizing that early intervention is one key factor to a successful outcome.