Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile?
Objective: To assess the feasibility of extracorporeal membrane oxygenation (ECMO) or life support (ECLS) as last resort life support therapy in patients with acute pancreatitis and subsequent secondary acute respiratory distress syndrome (ARDS). Methods: Retrospective analysis from January 2013, to...
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doaj-2a039b031d944309aff2c9fa2136da3d2021-03-03T00:01:00ZengMDPI AGJournal of Clinical Medicine2077-03832021-03-01101000100010.3390/jcm10051000Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile?Mathias Schmandt0Tim R. Glowka1Stefan Kreyer2Thomas Muders3Stefan Muenster4Nils Ulrich Theuerkauf5Jörg C. Kalff6Christian Putensen7Jens-Christian Schewe8Stefan Felix Ehrentraut9Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Surgery, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyObjective: To assess the feasibility of extracorporeal membrane oxygenation (ECMO) or life support (ECLS) as last resort life support therapy in patients with acute pancreatitis and subsequent secondary acute respiratory distress syndrome (ARDS). Methods: Retrospective analysis from January 2013, to April 2020, of ECMO patients with pancreatitis-induced ARDS at a German University Hospital. Demographics, hospital and ICU length of stay, duration of ECMO therapy, days on mechanical ventilation, fluid balance, need for decompressive laparotomy, amount of blood products, prognostic scores (CCI (Charlson Comorbidity Index), SOFA (Sequential Organ Failure Assessment), RESP(Respiratory ECMO Survival Prediction), SAVE (Survival after Veno-Arterial ECMO)), and the total known length of survival were assessed. Results: A total of <i>n</i> = 495 patients underwent ECMO. Eight patients with acute pancreatitis received ECLS (seven veno-venous, one veno-arterial). Five (71%) required decompressive laparotomy as salvage therapy due to abdominal hypertension. Two patients with acute pancreatitis (25%) survived to hospital discharge. The overall median length of survival was 22 days. Survivors required less fluid in the first 72 h of ECMO support and showed lower values for all prognostic scores. Conclusion: ECLS can be performed as a rescue therapy in patients with pancreatitis and secondary ARDS, but nevertheless mortality remains still high. Thus, this last-resort therapy may be best suited for patients with fewer pre-existing comorbidities and no other organ failure.https://www.mdpi.com/2077-0383/10/5/1000extra corporeal life support (ECLS)extra corporeal membrane oxygenation (ECMO)pancreatitisacute respiratory distress syndrome (ARDS) |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mathias Schmandt Tim R. Glowka Stefan Kreyer Thomas Muders Stefan Muenster Nils Ulrich Theuerkauf Jörg C. Kalff Christian Putensen Jens-Christian Schewe Stefan Felix Ehrentraut |
spellingShingle |
Mathias Schmandt Tim R. Glowka Stefan Kreyer Thomas Muders Stefan Muenster Nils Ulrich Theuerkauf Jörg C. Kalff Christian Putensen Jens-Christian Schewe Stefan Felix Ehrentraut Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? Journal of Clinical Medicine extra corporeal life support (ECLS) extra corporeal membrane oxygenation (ECMO) pancreatitis acute respiratory distress syndrome (ARDS) |
author_facet |
Mathias Schmandt Tim R. Glowka Stefan Kreyer Thomas Muders Stefan Muenster Nils Ulrich Theuerkauf Jörg C. Kalff Christian Putensen Jens-Christian Schewe Stefan Felix Ehrentraut |
author_sort |
Mathias Schmandt |
title |
Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? |
title_short |
Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? |
title_full |
Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? |
title_fullStr |
Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? |
title_full_unstemmed |
Secondary ARDS Following Acute Pancreatitis: Is Extracorporeal Membrane Oxygenation Feasible or Futile? |
title_sort |
secondary ards following acute pancreatitis: is extracorporeal membrane oxygenation feasible or futile? |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-03-01 |
description |
Objective: To assess the feasibility of extracorporeal membrane oxygenation (ECMO) or life support (ECLS) as last resort life support therapy in patients with acute pancreatitis and subsequent secondary acute respiratory distress syndrome (ARDS). Methods: Retrospective analysis from January 2013, to April 2020, of ECMO patients with pancreatitis-induced ARDS at a German University Hospital. Demographics, hospital and ICU length of stay, duration of ECMO therapy, days on mechanical ventilation, fluid balance, need for decompressive laparotomy, amount of blood products, prognostic scores (CCI (Charlson Comorbidity Index), SOFA (Sequential Organ Failure Assessment), RESP(Respiratory ECMO Survival Prediction), SAVE (Survival after Veno-Arterial ECMO)), and the total known length of survival were assessed. Results: A total of <i>n</i> = 495 patients underwent ECMO. Eight patients with acute pancreatitis received ECLS (seven veno-venous, one veno-arterial). Five (71%) required decompressive laparotomy as salvage therapy due to abdominal hypertension. Two patients with acute pancreatitis (25%) survived to hospital discharge. The overall median length of survival was 22 days. Survivors required less fluid in the first 72 h of ECMO support and showed lower values for all prognostic scores. Conclusion: ECLS can be performed as a rescue therapy in patients with pancreatitis and secondary ARDS, but nevertheless mortality remains still high. Thus, this last-resort therapy may be best suited for patients with fewer pre-existing comorbidities and no other organ failure. |
topic |
extra corporeal life support (ECLS) extra corporeal membrane oxygenation (ECMO) pancreatitis acute respiratory distress syndrome (ARDS) |
url |
https://www.mdpi.com/2077-0383/10/5/1000 |
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