Extracorporeal membrane oxygenation: a breakthrough for respiratory failure.

Area of Science:

• Cardiovascular and Respiratory Medicine
• Critical Care Medicine
• Medical Technology

Background:

• Extracorporeal membrane oxygenation (ECMO) provides life support for severe heart and/or lung failure when conventional intensive care is insufficient.
• The Stockholm programme has treated neonates since 1987 and adults since 1995, including interhospital transportation of unstable patients since 1996.
• The program emphasizes minimal patient sedation and has treated over 900 patients by December 2014.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of the Stockholm programme's ECMO treatment.
• To compare survival rates of the Stockholm programme with international data from the Extracorporeal Life Support Organization (ELSO) Registry.
• To identify specific conditions where the Stockholm programme demonstrates superior outcomes.

Main Methods:

• Retrospective analysis of patient data from the Stockholm programme up to December 2014.
• Comparison of survival to hospital discharge rates for neonatal, pediatric, and adult patients undergoing respiratory ECMO.
• Benchmarking outcomes against the ELSO Registry for overall performance and specific conditions like meconium aspiration syndrome, congenital diaphragmatic hernia, and pneumocystis pneumonia.

Main Results:

• The Stockholm programme treated approximately 80 patients annually, with a median ECMO duration of 5.3, 5.7, and 7.1 days for neonates, pediatrics, and adults, respectively.
• Survival rates to hospital discharge for respiratory ECMO were 81% (neonates), 70% (pediatrics), and 63% (adults), significantly exceeding ELSO Registry averages (74%, 57%, 57%).
• Significantly higher survival rates were observed in the Stockholm programme for meconium aspiration syndrome, congenital diaphragmatic hernia (neonates), and pneumocystis pneumonia (pediatrics) compared to ELSO data.

Conclusions:

• The Stockholm programme demonstrates superior outcomes in ECMO treatment for severe respiratory failure across all age groups compared to international benchmarks.
• The programme's approach, including interhospital transportation and minimal sedation, contributes to its high survival rates.
• ECMO is a vital life support intervention, and the Stockholm programme serves as a model for effective management of critical cardiorespiratory failure.