Matthieu Schmidt1,2, Tài Pham3,4, Antonio Arcadipane5, Cara Agerstrand6, Shinichiro Ohshimo7, Vincent Pellegrino8, Alain Vuylsteke9, Christophe Guervilly10, Shay McGuinness11, Sophie Pierard12, Jeff Breeding13, Claire Stewart14, Simon Sin Wai Ching15, Janice M Camuso16, R Scott Stephens17, Bobby King18, Daniel Herr19, Marcus J Schultz20, Mathilde Neuville21,22, Elie Zogheib23,24, Jean-Paul Mira25,26,27, Hadrien Rozé28, Marc Pierrot29, Anthony Tobin30, Carol Hodgson8,31, Sylvie Chevret32,33, Daniel Brodie6, Alain Combes1,2. 1. INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, UPMC Univ Paris 06, Sorbonne Université, Paris, France. 2. Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France. 3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 5. Department of Anesthesia and Intensive Care, IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e terapie ad alta specializzazione, Palermo, Italy. 6. Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. 7. Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. 8. Intensive Care Unit, Alfred Hospital, Melbourne, Australia. 9. Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom. 10. Center for Studies and Research on Health Services and Quality of Life EA3279, Service de Medecine Intensive et Reanimation, CHU Hopital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 11. Cardiothoracic & Vascular ICU, Auckland City Hospital, Auckland, New Zealand. 12. Pôle de Recherche Cardiovasculaire, Institute de Recherche Expérimentale et Clinique, Cardiothoracic Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 13. St. Vincent's Hospital, New South Wales, Sydney, Australia. 14. Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, New South Wales, Australia. 15. Department of Adult Intensive Care, Queen Mary Hospital, the University of Hong Kong, Hong Kong. 16. Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts. 17. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland. 18. Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. 19. University of Maryland, Baltimore, Maryland. 20. Academic Medical Center, Amsterdam, the Netherlands. 21. Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University, AP-HP, Paris, France. 22. UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France. 23. Cardiothoracic and Vascular Intensive Care Unit, Amiens University Hospital, Amiens, France. 24. INSERM U1088, Jules Verne University of Picardy, Amiens, France. 25. Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Médecine Intensive RéanimationHôpital Cochin, Paris, France. 26. Paris Descartes Sorbonne Paris Cité University, Paris, France. 27. Department of Infection, Immunity and Inflammation, Cochin Institute, Inserm U1016, Paris, France. 28. South Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Pessac, France. 29. Service de Réanimation Médicale, Centre Hospitalier Universitaire d'Angers, Angers, France. 30. Department of Critical Care Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia. 31. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. 32. Biostatistics Team, Saint-Louis Hospital, AP-HP, Paris, France; and. 33. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
Abstract
Rationale: Current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Objectives: To report current practices regarding mechanical ventilation in patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and their association with 6-month outcomes. Methods: This was an international, multicenter, prospective cohort study of patients undergoing ECMO for ARDS during a 1-year period in 23 international ICUs.Measurements and Main Results: We collected demographics, daily pre- and per-ECMO mechanical ventilation settings and use of adjunctive therapies, ICU, and 6-month outcome data for 350 patients (mean ± SD pre-ECMO PaO2/FiO2 71 ± 34 mm Hg). Pre-ECMO use of prone positioning and neuromuscular blockers were 26% and 62%, respectively. Vt (6.4 ± 2.0 vs. 3.7 ± 2.0 ml/kg), plateau pressure (32 ± 7 vs. 24 ± 7 cm H2O), driving pressure (20 ± 7 vs. 14 ± 4 cm H2O), respiratory rate (26 ± 8 vs. 14 ± 6 breaths/min), and mechanical power (26.1 ± 12.7 vs. 6.6 ± 4.8 J/min) were markedly reduced after ECMO initiation. Six-month survival was 61%. No association was found between ventilator settings during the first 2 days of ECMO and survival in multivariable analysis. A time-varying Cox model retained older age, higher fluid balance, higher lactate, and more need for renal-replacement therapy along the ECMO course as being independently associated with 6-month mortality. A higher Vt and lower driving pressure (likely markers of static compliance improvement) across the ECMO course were also associated with better outcomes.Conclusions: Ultraprotective lung ventilation on ECMO was largely adopted across medium- to high-case volume ECMO centers. In contrast with previous observations, mechanical ventilation settings during ECMO did not impact patients' prognosis in this context.
Rationale: Current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Objectives: To report current practices regarding mechanical ventilation in patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and their association with 6-month outcomes. Methods: This was an international, multicenter, prospective cohort study of patients undergoing ECMO for ARDS during a 1-year period in 23 international ICUs.Measurements and Main Results: We collected demographics, daily pre- and per-ECMO mechanical ventilation settings and use of adjunctive therapies, ICU, and 6-month outcome data for 350 patients (mean ± SD pre-ECMO PaO2/FiO2 71 ± 34 mm Hg). Pre-ECMO use of prone positioning and neuromuscular blockers were 26% and 62%, respectively. Vt (6.4 ± 2.0 vs. 3.7 ± 2.0 ml/kg), plateau pressure (32 ± 7 vs. 24 ± 7 cm H2O), driving pressure (20 ± 7 vs. 14 ± 4 cm H2O), respiratory rate (26 ± 8 vs. 14 ± 6 breaths/min), and mechanical power (26.1 ± 12.7 vs. 6.6 ± 4.8 J/min) were markedly reduced after ECMO initiation. Six-month survival was 61%. No association was found between ventilator settings during the first 2 days of ECMO and survival in multivariable analysis. A time-varying Cox model retained older age, higher fluid balance, higher lactate, and more need for renal-replacement therapy along the ECMO course as being independently associated with 6-month mortality. A higher Vt and lower driving pressure (likely markers of static compliance improvement) across the ECMO course were also associated with better outcomes.Conclusions: Ultraprotective lung ventilation on ECMO was largely adopted across medium- to high-case volume ECMO centers. In contrast with previous observations, mechanical ventilation settings during ECMO did not impact patients' prognosis in this context.
Authors: Joseph E Tonna; Craig H Selzman; Saket Girotra; Angela P Presson; Ravi R Thiagarajan; Lance B Becker; Chong Zhang; Peter Rycus; Heather T Keenan Journal: JACC Cardiovasc Interv Date: 2022-01-12 Impact factor: 11.195
Authors: Melissa M Felinski; Daniyal Abbas; Peter A Walker; John A Primomo; Tanyaradzwa M Kajese; Biswajit Kar; Igor D Gregoric; Igor Banjac; Lisa Janowiak; Sriram Nathan; Rahat Hussain; Sheilendra S Mehta; Kulvinder S Bajwa; Shinil K Shah; Bindu Akkanti Journal: J Extra Corpor Technol Date: 2021-09
Authors: Mazen F Odish; Jenny Yang; George Cheng; Cassia Yi; Eugene Golts; Michael Madani; Travis Pollema; Robert L Owens Journal: Crit Care Explor Date: 2021-05-14
Authors: Francesco Zadek; Jonah Rubin; Luigi Grassi; Daniel Van Den Kroonenberg; Grant Larson; Martin Capriles; Roberta De Santis Santiago; Gaetano Florio; David A Imber; Edward A Bittner; Kathryn A Hibbert; Alex Legassey; Jeliene LaRocque; Gaston Cudemus-Deseda; Aranya Bagchi; Jerome Crowley; Kenneth Shelton; Robert Kacmarek; Lorenzo Berra Journal: Crit Care Explor Date: 2021-06-29