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Introduction: To compare mortality and duration of mechanical ventilation in patients with severe ARDS who were treated using veno-veno extracorporeal membrane oxygenator (ECMO) as an adjunct to mechanical ventilation versus those treated with conventional ventilation alone. Hypothesis: Veno-veno ECMO in conjunction with very low tidal volume ventilation confers a survival benefit in patients with severe ARDS. Methods: We conducted a multicenter, retrospective matched cohort study of patients who had veno-veno ECMO for severe ARDS according to the Berlin classification. Patients from January 2007 to January 2012 were included. Each patient who received ECMO was matched to a control patient who did not receive ECMO on the following factors: APACHE IV, clinical site, lowest PF ratio 12 hours prior to ECMO and age. Conditional logistic regression and Wilcoxon signed-rank testing of matched pairs was used for the analysis. Results: The cohort of 66 patients included 33 who received ECMO with their corresponding matched pair who did not receive ECMO. Overall mean age was 40 ± 15 years and 41 (62%) were male. Mortality for patients treated with ECMO was significantly lower than conventional mechanical ventilation (11[34%] vs 21[66%], p=0.03). There were more median days of ICU admission (15, IQR[9-31] vs 6[1-23], p=0.01) and hospital admission (24[17-43] vs 16[2-31], p=0.02) for patients on ECMO. There was no difference in median 28 ventilator free days (0[0-18] vs 0[0-6], p=0.24). Complications related to the ECMO circuit included 2(6%) patients with oxygenator failure, 1 (3%) pump failure and 3(8.6%) with recirculation. Patients with significant patient complications included 1 (3%) intracranial hemorrhage, 5 (15.1%) with minor extremity ischemia, 4 (12.1%) with gastro-intestinal bleed. Patients who survived and successfully weaned had improvement of their static compliance from initiation to weaning on ECMO (21.5 to 28.3, p=0.02) compared to those were unable to be weaned (19.2 to 12.2, p =0.23). Conclusions: In this matched cohort study, use of ECMO in patients with severe ARDS is safe and associated with lower hospital mortality than conventional mechanical ventilation.

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