Association between Cumulative Fluid Balance and Outcomes in Acute Respiratory Distress Syndrome Patients Treated with Extracorporeal Membrane Oxygenation

Abstract

Background Extracorporeal membrane oxygenation (ECMO) has become increasingly accepted as a life-saving procedure for patients with severe acute respiratory distress syndrome (ARDS). This study investigated the relationship between cumulative fluid balance (CFB) and outcomes in adult ARDS patients treated with ECMO. Methods We retrospectively analyzed the data of adult ARDS patients who received ECMO between December 2009 and December 2019 at Korea University Anam Hospital. CFB was calculated during the first 7 days after ECMO initiation. The primary endpoint was 28-day mortality. Results The 74 patients were divided into survivor (n=33) and non-survivor (n=41) groups based on 28-day survival. Non-survivors showed a significantly higher CFB at 1–7 days (p<0.05). Cox multivariable proportional hazard regression revealed a relationship between CFB on day 3 and 28-day mortality (hazard ratio, 3.366; 95% confidence interval, 1.528–7.417; p=0.003). Conclusion In adult ARDS patients treated with ECMO, a higher positive CFB on day 3 was associated with increased 28-day mortality. Based on our findings, we suggest a restrictive fluid strategy in ARDS patients treated with ECMO. CFB may be a useful predictor of survival in ARDS patients treated with ECMO.

Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome Received Extracorporeal Membrane Oxygenation: A Prospective Cohort Study

“…Fluid balance is associated with the outcome of patients on ECMO. Lee et al ( 28 ) reported that a higher positive cumulative fluid balance on Day 3 of ECMO was associated with increased 28-day mortality. In the present study, daily fluid balance during the first 3 days of ECMO support was significantly correlated to LUS score, and LUS score ≥ 24 after 72 h ECMO support was associated with a worse outcome in patients with pARDS.…”

Effects of changes in veno-venous extracorporeal membrane oxygenation blood flow on the measurement of intrathoracic blood volume and extravascular lung water index: a prospective interventional study

“…For the most severe cases, veno-venous extracorporeal membrane oxygenation (V-V ECMO) has been proposed as an alternative therapeutic strategy that might reduce mortality [3][4][5]. A restrictive fluid management is recommended in patients with ARDS managed with V-V ECMO [6,7] because an excessive positive fluid balance increases mortality [8]. Transpulmonary thermodilution (TPTD) allows us to quantify pulmonary edema from the measurement of the extravascular lung water index (EVLWI) and for continuous monitoring of cardiac preload parameters such as the intrathoracic blood volume index (ITBVI) [9][10][11], which is mathematically derived from the global end-diastolic volume index (GEDVI).…”