Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study

(1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricu...

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Main Authors: Stefan Muenster, Jennifer Nadal, Jens-Christian Schewe, Heidi Ehrentraut, Stefan Kreyer, Christian Putensen, Stefan Felix Ehrentraut
Format: Article
Language:English
Published: MDPI AG 2024-03-01
Series:Journal of Clinical Medicine
Subjects:
Online Access:https://www.mdpi.com/2077-0383/13/6/1555
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author Stefan Muenster
Jennifer Nadal
Jens-Christian Schewe
Heidi Ehrentraut
Stefan Kreyer
Christian Putensen
Stefan Felix Ehrentraut
author_facet Stefan Muenster
Jennifer Nadal
Jens-Christian Schewe
Heidi Ehrentraut
Stefan Kreyer
Christian Putensen
Stefan Felix Ehrentraut
author_sort Stefan Muenster
collection DOAJ
description (1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricular failure (RV failure). (2) <b>Methods</b>: Out of 662 ECMO-supported patients, 366 received VV ECMO, including 48 who inhaled NO. We examined the NO’s indications, dosing, duration, and the ability to lower PAH. We compared patients with and without inhaled NO in terms of mechanical ventilation duration, ECMO weaning, organ dysfunction, in-hospital mortality, and survival. (3) <b>Results</b>: Patients received 14.5 ± 5.5 ppm NO for 3 days with only one-third experiencing decreased pulmonary arterial pressure. They spent more time on VV ECMO, had a higher ECMO weaning failure frequency, and elevated severity scores (SAPS II and TIPS). A Kaplan–Meier analysis revealed reduced survival in the NO group. Multiple variable logistic regression indicated a twofold increased risk of death for ARDS patients on VV ECMO with NO. We observed no increase in continuous renal replacement therapy. (4) <b>Conclusions</b>: This study suggests that persistent PAH and/or RV failure is associated with poorer outcomes in severe ARDS patients on VV-ECMO, with an inhaled NO responder rate of only 30%, and it does not impact acute kidney failure rates.
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spelling doaj.art-927874409ed1401a80bfc37ab8c95dfc2024-03-27T13:47:41ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01136155510.3390/jcm13061555Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational StudyStefan Muenster0Jennifer Nadal1Jens-Christian Schewe2Heidi Ehrentraut3Stefan Kreyer4Christian Putensen5Stefan Felix Ehrentraut6Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyInstitute of Medical Biometry, Informatics and Epidemiology, 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 Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany(1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricular failure (RV failure). (2) <b>Methods</b>: Out of 662 ECMO-supported patients, 366 received VV ECMO, including 48 who inhaled NO. We examined the NO’s indications, dosing, duration, and the ability to lower PAH. We compared patients with and without inhaled NO in terms of mechanical ventilation duration, ECMO weaning, organ dysfunction, in-hospital mortality, and survival. (3) <b>Results</b>: Patients received 14.5 ± 5.5 ppm NO for 3 days with only one-third experiencing decreased pulmonary arterial pressure. They spent more time on VV ECMO, had a higher ECMO weaning failure frequency, and elevated severity scores (SAPS II and TIPS). A Kaplan–Meier analysis revealed reduced survival in the NO group. Multiple variable logistic regression indicated a twofold increased risk of death for ARDS patients on VV ECMO with NO. We observed no increase in continuous renal replacement therapy. (4) <b>Conclusions</b>: This study suggests that persistent PAH and/or RV failure is associated with poorer outcomes in severe ARDS patients on VV-ECMO, with an inhaled NO responder rate of only 30%, and it does not impact acute kidney failure rates.https://www.mdpi.com/2077-0383/13/6/1555inhaled nitric oxidesevere ARDSVV ECMOpulmonary hypertensioninhaled nitric oxide responder
spellingShingle Stefan Muenster
Jennifer Nadal
Jens-Christian Schewe
Heidi Ehrentraut
Stefan Kreyer
Christian Putensen
Stefan Felix Ehrentraut
Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
Journal of Clinical Medicine
inhaled nitric oxide
severe ARDS
VV ECMO
pulmonary hypertension
inhaled nitric oxide responder
title Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
title_full Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
title_fullStr Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
title_full_unstemmed Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
title_short Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
title_sort analysis of patients with severe ards on vv ecmo treated with inhaled no a retrospective observational study
topic inhaled nitric oxide
severe ARDS
VV ECMO
pulmonary hypertension
inhaled nitric oxide responder
url https://www.mdpi.com/2077-0383/13/6/1555
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