Introduction Patients with interstitial lung disease (ILD) and severe respiratory failure (SRF) requiring mechanical ventilation are widely perceived to have poor outcomes. A therapeutic strategy incorporating extracorporeal membrane oxygenation (ECMO) improves all cause SRF survival. There exist no data on the use of ECMO in severe ILD. ECMO may offer lung rest, reduce the inflammatory burden associated with mechanical ventilation and allow time for effective immunosuppression. We hypothesised that the use of ECMO and early immunosuppression increases survival in patients with ILD in whom mechanical ventilation was failing.
Methods Retrospective interrogation of a single centre ECMO database for patients with ILD between 2011 and 2014. Variables collected included diagnosis; immunosuppression regimen; duration of symptoms prior to ECMO initiation; serum biochemistry; clinical severity score (SOFA) and survival to ECMO decannulation, ICU discharge and at 6 months. ECMO centre admission computed tomography (CT) thorax scans were independently analysed for pattern and degree of abnormality by two radiologists. Variables were compared between responders (those who survived without lung transplant) and non responders (composite group of those who died and one patient who survived with lung transplantation). Two-tailed t-tests were used for all comparisons.
Results 12 patients with an ILD diagnosis who received ECMO were identified. ECMO and ICU survival was 58.3%. The group of responders had a shorter duration of symptoms prior to ECMO (p = 0.04), a higher CRP (p = 0.046), a higher SOFA score (p = 0.01) and a lower preponderance of diffuse alveolar damage (DAD) on CT (p = 0.19) although there was no difference in overall extent of CT abnormality. (Table 1).
Conclusions The use of ECMO and early immunosuppression led to a 58.3% survival in a group of ILD associated SRF who would otherwise have been highly likely to die. The responders were characterised by a more acute and more inflammatory presentation. We suggest that ECMO and immunosuppression should be considered in patients with ILD and SRF who are failing mechanical ventilation.