Burns : journal of the International Society for Burn Injuries · 2026
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute respiratory distress syndrome (ARDS) in severely burn-injured patients: A single-center cohort study of outcome predictors and longitudinal ECMO dynamics.
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Macedo Santos Elisabete, Schmidt Sonja Verena, Buchwald Dirk, Steubing Yonca, Wallner Christoph, Zahn Peter Konrad, Lehnhardt Marcus, Hinzmann Jannik
Аннотация
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a major complication in severely burn-injured patients and is associated with high mortality. In refractory respiratory failure, veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as rescue therapy. However, evidence in burn-injured patients remains limited, and burn-specific predictors of outcome are poorly defined.
METHODS: This retrospective single-center cohort study included all severely burn-injured patients with ARDS treated with V-V ECMO between January 2022 and October 2025. Survivors and non-survivors were compared regarding burn characteristics, clinical course, ECMO-related parameters, and complications. Longitudinal physiological and ECMO-specific parameters, including blood flow, sweep gas flow, lactate, and gas exchange variables, were analyzed.
RESULTS: Sixteen patients were included. Successful ECMO weaning was achieved in 56.3%. Survival at 30 and 60 days after ECMO initiation was 50%, while one-year survival was 33.3%. Non-survivors showed greater burn severity, reflected by higher total body surface area (TBSA), more full-thickness burns, and higher abbreviated burn severity index (ABSI) and revised Baux scores. At ECMO initiation, they exhibited greater physiological derangement, including higher sequential organ failure assessment scores (SOFA), lactate levels, and coagulation abnormalities. The respiratory ECMO survival prediction score (RESP) showed limited discriminatory value. Blood flow and sweep gas flow were comparable between groups, whereas non-survivors demonstrated persistently elevated lactate levels, higher PaCO₂, and lower pH despite maintained oxygenation.
CONCLUSIONS: V-V ECMO is a feasible rescue strategy in selected severely burn-injured patients with ARDS, but mortality remains high and appears to be driven predominantly by burn-specific and systemic factors rather than respiratory failure alone. Burn severity markers and early physiological trajectories may provide valuable prognostic information.
METHODS: This retrospective single-center cohort study included all severely burn-injured patients with ARDS treated with V-V ECMO between January 2022 and October 2025. Survivors and non-survivors were compared regarding burn characteristics, clinical course, ECMO-related parameters, and complications. Longitudinal physiological and ECMO-specific parameters, including blood flow, sweep gas flow, lactate, and gas exchange variables, were analyzed.
RESULTS: Sixteen patients were included. Successful ECMO weaning was achieved in 56.3%. Survival at 30 and 60 days after ECMO initiation was 50%, while one-year survival was 33.3%. Non-survivors showed greater burn severity, reflected by higher total body surface area (TBSA), more full-thickness burns, and higher abbreviated burn severity index (ABSI) and revised Baux scores. At ECMO initiation, they exhibited greater physiological derangement, including higher sequential organ failure assessment scores (SOFA), lactate levels, and coagulation abnormalities. The respiratory ECMO survival prediction score (RESP) showed limited discriminatory value. Blood flow and sweep gas flow were comparable between groups, whereas non-survivors demonstrated persistently elevated lactate levels, higher PaCO₂, and lower pH despite maintained oxygenation.
CONCLUSIONS: V-V ECMO is a feasible rescue strategy in selected severely burn-injured patients with ARDS, but mortality remains high and appears to be driven predominantly by burn-specific and systemic factors rather than respiratory failure alone. Burn severity markers and early physiological trajectories may provide valuable prognostic information.