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

초록

Background: Extracorporeal membrane oxygenation (ECMO) has become increasingly accepted as a life-saving procedure for patients with severe acute respiratory distress syn- drome (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 be- tween 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 re- strictive fluid strategy in ARDS patients treated with ECMO. CFB may be a useful predictor of survival in ARDS patients treated with ECMO.

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