Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat, EOLIA Trial Group, REVA, and ECMONet, Djillali Annane, Bruno Megarbane, Armand Dessap, Jean-Daniel Chiche, Nadia Aissaoui, Yves Le Tulzo, Jean-Damien Ricard, Antoine Vieillard-Baron, Jacques Duranteau, Sébastien Jochmans, Arnaud Foucrier, Hervé Mentec, Guillaume Lacave, Kenneth Ekpe, Caroline Bornstain, Fabienne Fieux, Mikael Alves, Sophie Marque, Frank Chemouni, Jean-Philippe Rigaud, Mehdi Bousta, Elie Zogheib, Vincent Pellegrino, Daniel Herr, Matthew Bacchetta, Nicolas Bréchot, Jean Chastre, Guillaume Hékimian, Pascal Leprince, Cosimo D’Alessandro, Charles Luyt, Ania Nieszkowska, Matthieu Schmidt, Jean-Louis Trouillet, Abdallah Fayssoil, Virginie Maxime, Virginie Lemiale, Elie Azoulay, Nicolas Deye, Guillaume Carteaux, François Belon, Hadrien Winiszewski, Nicolas Belin, Julien Charpentier, Jean Luc Diehl, Morgane Commereuc, Jean-Luc Baudel, Hafid Ait Oufella, Naike Bigé, Bertrand Guidet, Dorothée Carpentier, Fabien Doguet, Arnaud Gacouin, Jean-Cristophe Callahan, Mickael Landais, Nicolas Chudeau, Charlène Le Moal, Fabien Grelon, Marc Pierrot, Laurent Papazian, Antoine Roch, Jean-Marie Forel, Sami Hraiech, Mélanie Adda, Romain Rambaud, Benjamin Coiffard, Stéphane Gaudry, Jonathan Messika, Damien Roux, Didier Dreyfuss, David Osman, Nadia Anguel, Pierre Gildas Guitard, Philippe Gouin, Anna Lamacz, Thierry Lherm, Olivier Gontier, Abdelkader Ouchenir, Juliette Audibert, Alexandre Conia, Adel Ben Salah, Mouldi Hamrouni, Martin Dres, Julien Mayaux, Elise Morawiec, Hélène Prodanovic, Xavier Repesse, Jean-François Timsit, Romain Sonneville, Bruno Mourvillier, Mathilde Neuville, Michel Wolff, Anatole Harrois, Oumar Sy, Jean-Emmanuel Alphonsine, Olivier Ellrodt, Gabriel Preda, Luis Ferreira, Laurent Lainé, Etienne De Montmollin, Bruno Verdière, Nathalie Mémain, Catherine Paugam-Burtz, Jean Mantz, Hélène Bout, Marina Thirion, Julia Hilly-ginoux, Johanna Oziel, Annabelle Stoclin, François Blot, Caroline Borstain, Hervé Outin, Pierrick Cronier, Laure Gazaigne, Pierre Garçon, Pierre-Louis Declercq, Eric Frenoy, Guillaume Schnell, Edouard Perdue Legendre, Emmanuel Novy, Thomas Auchet, Elsa Tahon, Dabor Resiere, Marie Sabia, François Roques, Hervé Dupont, Pierre-Alexandre Roger, Jamie Cooper, Jasmin Board, Shirley Vallance, Kimberly Boswell, Ali Tabatabai, Joshua Sonett, Cara Agerstrand, Darryl Abrams, Shaf Keshavjee, Marcelo Cypel, Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat, EOLIA Trial Group, REVA, and ECMONet, Djillali Annane, Bruno Megarbane, Armand Dessap, Jean-Daniel Chiche, Nadia Aissaoui, Yves Le Tulzo, Jean-Damien Ricard, Antoine Vieillard-Baron, Jacques Duranteau, Sébastien Jochmans, Arnaud Foucrier, Hervé Mentec, Guillaume Lacave, Kenneth Ekpe, Caroline Bornstain, Fabienne Fieux, Mikael Alves, Sophie Marque, Frank Chemouni, Jean-Philippe Rigaud, Mehdi Bousta, Elie Zogheib, Vincent Pellegrino, Daniel Herr, Matthew Bacchetta, Nicolas Bréchot, Jean Chastre, Guillaume Hékimian, Pascal Leprince, Cosimo D’Alessandro, Charles Luyt, Ania Nieszkowska, Matthieu Schmidt, Jean-Louis Trouillet, Abdallah Fayssoil, Virginie Maxime, Virginie Lemiale, Elie Azoulay, Nicolas Deye, Guillaume Carteaux, François Belon, Hadrien Winiszewski, Nicolas Belin, Julien Charpentier, Jean Luc Diehl, Morgane Commereuc, Jean-Luc Baudel, Hafid Ait Oufella, Naike Bigé, Bertrand Guidet, Dorothée Carpentier, Fabien Doguet, Arnaud Gacouin, Jean-Cristophe Callahan, Mickael Landais, Nicolas Chudeau, Charlène Le Moal, Fabien Grelon, Marc Pierrot, Laurent Papazian, Antoine Roch, Jean-Marie Forel, Sami Hraiech, Mélanie Adda, Romain Rambaud, Benjamin Coiffard, Stéphane Gaudry, Jonathan Messika, Damien Roux, Didier Dreyfuss, David Osman, Nadia Anguel, Pierre Gildas Guitard, Philippe Gouin, Anna Lamacz, Thierry Lherm, Olivier Gontier, Abdelkader Ouchenir, Juliette Audibert, Alexandre Conia, Adel Ben Salah, Mouldi Hamrouni, Martin Dres, Julien Mayaux, Elise Morawiec, Hélène Prodanovic, Xavier Repesse, Jean-François Timsit, Romain Sonneville, Bruno Mourvillier, Mathilde Neuville, Michel Wolff, Anatole Harrois, Oumar Sy, Jean-Emmanuel Alphonsine, Olivier Ellrodt, Gabriel Preda, Luis Ferreira, Laurent Lainé, Etienne De Montmollin, Bruno Verdière, Nathalie Mémain, Catherine Paugam-Burtz, Jean Mantz, Hélène Bout, Marina Thirion, Julia Hilly-ginoux, Johanna Oziel, Annabelle Stoclin, François Blot, Caroline Borstain, Hervé Outin, Pierrick Cronier, Laure Gazaigne, Pierre Garçon, Pierre-Louis Declercq, Eric Frenoy, Guillaume Schnell, Edouard Perdue Legendre, Emmanuel Novy, Thomas Auchet, Elsa Tahon, Dabor Resiere, Marie Sabia, François Roques, Hervé Dupont, Pierre-Alexandre Roger, Jamie Cooper, Jasmin Board, Shirley Vallance, Kimberly Boswell, Ali Tabatabai, Joshua Sonett, Cara Agerstrand, Darryl Abrams, Shaf Keshavjee, Marcelo Cypel
Abstract
Background: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial.
Methods: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 50 mm Hg for more than 3 hours; a Pao2:Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7.25 with a partial pressure of arterial carbon dioxide of at least 60 mm Hg for more than 6 hours - to receive immediate venovenous ECMO (ECMO group) or continued conventional treatment (control group). Crossover to ECMO was possible for patients in the control group who had refractory hypoxemia. The primary end point was mortality at 60 days.
Results: At 60 days, 44 of 124 patients (35%) in the ECMO group and 57 of 125 (46%) in the control group had died (relative risk, 0.76; 95% confidence interval [CI], 0.55 to 1.04; P=0.09). Crossover to ECMO occurred a mean (±SD) of 6.5±9.7 days after randomization in 35 patients (28%) in the control group, with 20 of these patients (57%) dying. The frequency of complications did not differ significantly between groups, except that there were more bleeding events leading to transfusion in the ECMO group than in the control group (in 46% vs. 28% of patients; absolute risk difference, 18 percentage points; 95% CI, 6 to 30) as well as more cases of severe thrombocytopenia (in 27% vs. 16%; absolute risk difference, 11 percentage points; 95% CI, 0 to 21) and fewer cases of ischemic stroke (in no patients vs. 5%; absolute risk difference, -5 percentage points; 95% CI, -10 to -2).
Conclusions: Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .).
Source: PubMed