Decades old studies suggested no improvement in outcomes for ARDS treated with extracorporeal membrane oxygenation (ECMO). Up until now the treatment has been viewed as a last resort. New evidence presented at the Society of Critical Care Medicine 37th Critical Care Congress (via Medscape) suggests it should be considered early in certain patients.
Most patients with ARDS die of causes other than hypoxemia, such as infection or the underlying disease that was a risk factor for ARDS. Those who appear at risk of dying of respiratory failure may be worthy of consideration for ECMO. The investigators used a Murray score of 3 or more as a criterion for patient selection.
The Murray score calculator is here. The study web site can be accessed here.
This evidence will undoubtedly cause a shift in thinking about ECMO. It remains to be seen how it should be incorporated into clinical practice, especially in hospitals lacking this capability. Should patients be shipped?