Outcomes Using Extracorporeal Life Support for Adult Respiratory Failure due to Status Asthmaticus

Abstract

Our objective was to describe the outcomes for extracorporeal life support (ECLS) use in adult respiratory failure due to status asthmaticus and to determine whether ECLS use in status asthmaticus is associated with greater survival than other indications for ECLS. This retrospective cohort study used the multi-center, international extracorporeal life support organization registry. The study population included 1257 adults with respiratory failure requiring ECLS. Status asthmaticus was the primary indication for ECLS in 24 patients. 83.3% of asthmatics survived to hospital discharge, compared to 50.8% of non-asthmatics (n=1233) (OR favoring survival for asthmatics = 4.86, 95%CI 1.65–14.31, p=0.004). The survival advantage for asthmatics remained significant after adjustment for potential confounders. Complications were noted in 19 of 24 asthmatics (79.2%). In conclusion, we found that status asthmaticus, as an indication for ECLS in adult respiratory failure, appeared to be associated with greater survival than other indications for ECLS. However, complications are common and whether ECLS confers a survival advantage compared to other salvage treatment options remains unknown. More detailed information and complete reporting of ECLS use for status asthmaticus are needed to determine whether and when the potentially life-saving intervention of ECLS should be initiated in the asthmatic failing conventional therapy.

ECLS indication for a case of stress myocardiopathy associated with severe asthma

“…However, several cases of ECLS use for asthmatic rescue have been described [4,5]. A retrospective study concerning acute respiratory failure needing ECLS, found only 1.9% cases related to asthma [6]. Mainly, there were veno-venous (VV) cases of ECLS and rarely veno-arterial cases.…”

Extracorporeal Membrane Oxygenation for Status Asthmaticus: A Case Report Ecmo for Status Asthmaticus

“…In a 2009 retrospective cohort registry review of the interna tional Extracorporeal Life Support Organization Registry, among 1,257patients treated with ECMO, only 24 (2%) were asthmatics. Yet, survival to discharge was much higher for the asthmatic group (83%) as compared to non-asthmatics (50.8%), even after adjustment for confounders [5].…”

Novel Uses of Extracorporeal Membrane Oxygenation in Adults

“…Data from small studies are promising, but larger randomized trials compared with conventional mechanical ventilation are necessary for chronic obstructive pulmonary disease, as well as status asthmaticus and other causes of hypercapnic respiratory failure. 35,36 Patients with acute hypercapnic respiratory failure are well-suited for extracorporeal support because of the efficiency with which EC-CO 2 R ameliorates hypercapnia and respiratory acidosis. A subset of patients with ECCO 2 R-supported hypercapnic respiratory failure may be appropriate candidates for removal of invasive mechanical ventilation.…”