Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Extracorporeal membrane oxygenation in life-threatening asthma unresponsive to mechanical ventilation: a comparison of patient demographics and outcomes between a large London-based intensive care unit and an international registry

Kritchai Vutipongsatorn, Eri Fujitake and Suveer Singh
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.19-3s-s19
Clin Med June 2019
Kritchai Vutipongsatorn
AImperial College London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eri Fujitake
AImperial College London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Suveer Singh
BRoyal Brompton Hospital, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Introduction

According to the British Thoracic Society (BTS) guidelines,1 extracorporeal membrane oxygenation (ECMO) may be considered in near-fatal asthma exacerbations refractory to conventional ventilator treatment. However, there is currently no clear criteria for accepting such patients for ECMO treatment. The comparison of local data to an internationally established database would lead to a better insight into optimal criteria for the commencement of ECMO treatment.

Methods

Medical records of asthmatic patients who were admitted to Royal Brompton Hospital (RBH) for ECMO from 2012 to 2018 were reviewed. Parameters such as pre- and post-ECMO blood gases, ventilator settings and outcomes were calculated and compared with the Extracorporeal Life Support Organization (ELSO) registry,2 an international database for ECMO from 1992 to 2016 (n=272).

Results and discussion

Ten patients (38.4 ± 13.6 years) were identified. Sixty per cent were known asthmatics, and 40% had previous hospital admissions for asthma. Eighty per cent had an infective trigger. The mean duration on ECMO and stay on intensive treatment unit (ITU) were 6.7 ± 2.9 days and 11.9 ± 5.3 days, respectively. Compared with the ELSO registry, there were no significant differences in patient demographics. Prior to ECMO, RBH patients were significantly more hypercapnic (16.0 vs 10.7 kPa, p=0.014), and were on a significantly less aggressive ventilator setting with regards to FiO2 (57.1% vs 81.2%, p=0.002) and positive end-expiratory pressure (PEEP) (4.3 vs 8.3 kPa, p=0.043). However, there were no significant differences in survival (100% vs 83.5%, p=0.363) or duration on ECMO (6.7 vs 7.4 days, p=0.785). The pre-ECMO blood gas and ventilation settings could indicate a higher threshold for commencing ECMO in the RBH cohort, or the result of less aggressive ventilation settings prior to starting ECMO. However, this had no impact on survival and duration on ECMO.

Conclusion

Despite similar outcomes, there are significant differences in the RBH cohort with regards to the pre-ECMO ventilation settings and blood gases. As recommended by the BTS, further research of a bigger sample size is required to improve understanding of treatment-refractory fatal asthma.

Conflict of interest statement

None declared.

  • © Royal College of Physicians 2019. All rights reserved.

References

  1. ↵
    1. British Thoracic Society and Scottish Intercollegiate Guidelines Network
    . British Guideline on the management of asthma. BTS, 2016. www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-guideline-on-the- management-of-asthma/ [Accessed 21 February 2019].
  2. ↵
    1. Yeo HJ
    , Kim D, Jeon D, Kim YS, Rycus P, Cho WH. Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry. Crit Care 2017;21:297
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Extracorporeal membrane oxygenation in life-threatening asthma unresponsive to mechanical ventilation: a comparison of patient demographics and outcomes between a large London-based intensive care unit and an international registry
Kritchai Vutipongsatorn, Eri Fujitake, Suveer Singh
Clinical Medicine Jun 2019, 19 (Suppl 3) s19; DOI: 10.7861/clinmedicine.19-3s-s19

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Extracorporeal membrane oxygenation in life-threatening asthma unresponsive to mechanical ventilation: a comparison of patient demographics and outcomes between a large London-based intensive care unit and an international registry
Kritchai Vutipongsatorn, Eri Fujitake, Suveer Singh
Clinical Medicine Jun 2019, 19 (Suppl 3) s19; DOI: 10.7861/clinmedicine.19-3s-s19
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Methods
    • Results and discussion
    • Conclusion
    • Conflict of interest statement
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Haemopoietic stem cell transplantation is a curative treatment option with minimal transplant-related complications for patients with severe Glanzmann's thrombasthenia
  • The monitoring and incidence of hyperglycaemia in inflammatory bowel disease patients treated with intravenous steroids
  • Clinical dynamics of nephropathy in patients with diabetes mellitus type 2 and concomitant essential hypertensive disease
Show more Clinical

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians