Cardinality Matching Study of Early v.s. Delayed VV ECMO in Severe Respiratory Failure
Clinical reasoning and recent data suggest that early use of venovenous extracorporeal membrane oxygenation in refractory respiratory failure may confer a survival advantage.
This retrospective matched study will assess whether patients who received VV ECMO at less severe hypoxaemia had differing outcomes to those who received ECMO with very severe hypoxaemia.
調査の概要
詳細な説明
VV ECMO is increasingly used in refractory respiratory failure. Despite advances in lung protective ventilation strategies, patients who have severe respiratory failure often develop complications from mechanical ventilation, including volutrauma and barotrauma. ECMO allows gas exchange to occur extracorporeally and may reduce the potential burden of iatrogenic lung injury by allowing a reduction of volume and pressure support - a 'lung rest' strategy. It is theorised that earlier intitiation of ECMO may allow for better outcomes, as there will have been less time for iatrogenic lung injury to occur.
The UK ECMO registry has been collected of patients treated under the NHS England commissioned respiratory ECMO service since 2011. This study has been previously registered and publication is intended shortly.
Patients will be extracted from this registry if they received VV ECMO. Propensity matching scores will be created and patients will be stratified into groups of 'early' vs 'delayed' ECMO, based on their probability of being in either group.
Patients will be divided into cohorts based on the median PaO2/FiO2 ratio at decision to cannulate ('less severe hypoxaemia') and ('very severe hypoxaemia'). Matched cohorts will be created correcting for key confounding factors (age, primary diagnosis, duration of pre-ECMO ventilation and PaCO2), using cardinality matching (a novel technique described by Zubizaretta et al. in 2014) and traditional propensity-score-based methods.
The technique with greater balance and statistical power (as defined by sample size) will be selected for the primary analysis.
Further analyses will assess the relationship between hypoxaemia at decision-to-cannulate and confounding factors as above.
研究の種類
入学 (実際)
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Patients included in the UK ECMO registry (see previous registration; NCT number awaited; protocol ECMO-001)
- Patients with VV ECMO
Exclusion Criteria:
- Patients with inadequate or missing data for creation of propensity score models.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 観測モデル:コホート
- 時間の展望:回顧
コホートと介入
グループ/コホート |
---|
'Less severe hypoxaemia'
PaO2/FiO2 ratio > 68 mmHg (9.1kPa) at decision-to-cannulate
|
'Very severe hypoxaemia'
PaO2/FiO2 ratio ≤ 68 mmHg (9.1kPa) at decision-to-cannulate
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Survival to ECMO ICU discharge
時間枠:Up to 90 days.
|
Percentage of patients alive at discharge from the ICU at the specialist ECMO centre
|
Up to 90 days.
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Duration of ECMO treatment
時間枠:Up to 90 days.
|
Duration spent supported by active ECMO treatment.
|
Up to 90 days.
|
協力者と研究者
スポンサー
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。