Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome
Alain Combes
(1, 2, 3)
,
David Hajage
(4, 5)
,
Gilles Capellier
(6, 7)
,
Alexandre Demoule
(8, 4)
,
Sylvain Lavoué
(9)
,
Christophe Guervilly
(10)
,
Daniel da Silva
(11)
,
Lara Zafrani
(12)
,
Patrice Tirot
(13)
,
Benoit Veber
(14)
,
Eric Maury
(15)
,
Bruno Levy
(16, 17)
,
Yves Cohen
(18)
,
Christian Richard
(19)
,
Pierre Kalfon
(20)
,
Lila Bouadma
(21)
,
Hossein Mehdaoui
(22)
,
Gaëtan Beduneau
(14, 23)
,
Guillaume Lebreton
(1, 2, 3)
,
Laurent Brochard
(24, 25)
,
Niall Ferguson
(24, 26)
,
Eddy Fan
(24, 26)
,
Arthur Slutsky
(25)
,
Daniel Brodie
(27)
,
Alain Mercat
(28, 29)
1
ICAN -
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 IHU ICAN - Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière]
3 Institut de cardiologie [CHU Pitié-Salpêtrière]
4 CHU Pitié-Salpêtrière [AP-HP]
5 SU - Sorbonne Université
6 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
7 UFC - Université de Franche-Comté
8 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
10 Hôpital Nord [CHU - APHM]
11 Centre Hospitalier de Saint-Denis [Ile-de-France]
12 AP-HP - Hopital Saint-Louis [AP-HP]
13 Centre Hospitalier Le Mans (CH Le Mans)
14 CHU Rouen
15 CHU Saint-Antoine [AP-HP]
16 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
17 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
18 Hôpital Avicenne [AP-HP]
19 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
20 Hôpitaux de Chartres [Chartres]
21 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
22 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
23 UNIROUEN - Université de Rouen Normandie
24 University of Toronto
25 St. Michael's Hospital
26 Mount Sinai Health System
27 CUMC - Columbia University Medical Center
28 CHU Angers - Centre Hospitalier Universitaire d'Angers
29 UA - Université d'Angers
2 IHU ICAN - Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière]
3 Institut de cardiologie [CHU Pitié-Salpêtrière]
4 CHU Pitié-Salpêtrière [AP-HP]
5 SU - Sorbonne Université
6 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
7 UFC - Université de Franche-Comté
8 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
10 Hôpital Nord [CHU - APHM]
11 Centre Hospitalier de Saint-Denis [Ile-de-France]
12 AP-HP - Hopital Saint-Louis [AP-HP]
13 Centre Hospitalier Le Mans (CH Le Mans)
14 CHU Rouen
15 CHU Saint-Antoine [AP-HP]
16 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
17 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
18 Hôpital Avicenne [AP-HP]
19 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
20 Hôpitaux de Chartres [Chartres]
21 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
22 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
23 UNIROUEN - Université de Rouen Normandie
24 University of Toronto
25 St. Michael's Hospital
26 Mount Sinai Health System
27 CUMC - Columbia University Medical Center
28 CHU Angers - Centre Hospitalier Universitaire d'Angers
29 UA - Université d'Angers
Alain Combes
- Fonction : Auteur
- PersonId : 999809
- ORCID : 0000-0002-6030-3957
- IdRef : 033468192
Guillaume Lebreton
- Fonction : Auteur
Résumé
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 .).