Meta-Analysis

. 2016 Nov;42(11):1672-1684.

doi: 10.1007/s00134-016-4507-0. Epub 2016 Sep 1.

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO

Ary Serpa Neto^{1

2

3}, Matthieu Schmidt^{4

5}, Luciano C P Azevedo^{6

7}, Thomas Bein⁸, Laurent Brochard^{9

10

11}, Gernot Beutel¹², Alain Combes^{5

13}, Eduardo L V Costa^{6

7}, Carol Hodgson^{4

14}, Christian Lindskov¹⁵, Matthias Lubnow¹⁶, Catherina Lueck¹², Andrew J Michaels¹⁷, Jose-Artur Paiva¹⁸, Marcelo Park^{6

7}, Antonio Pesenti^{19

20}, Tài Pham^{21

22

23}, Michael Quintel²⁴, V Marco Ranieri²⁵, Michael Ried²⁶, Roberto Roncon-Albuquerque Jr¹⁸, Arthur S Slutsky²⁷, Shinhiro Takeda²⁸, Pier Paolo Terragni²⁹, Marie Vejen¹⁵, Steffen Weber-Carstens³⁰, Tobias Welte³¹, Marcelo Gama de Abreu³², Paolo Pelosi³³, Marcus J Schultz^{34

35}; ReVA Research Network and the PROVE Network Investigators

Collaborators, Affiliations

Collaborators

ReVA Research Network and the PROVE Network Investigators:
E Zogheib, H Dupont, A Mercat, M Pierrot, G Capellier, B Verdiere, O Bastien, J J Lehot, J M Tonnelier, D Guelon, D du Cheyron, A Thille, T Pham, C Brun-Buisson, J P Quenot, Arasomoano, C Minet, J F Timsit, G Dessertaine, L Robriquet, E Jaillette, M Castanier, A Roch, L Papazian, J Eliet, P Gaudard, S Machado, K Kuteifan, A Kimmoun, B Levy, P Bizouarn, D Villiers, C Guitton, J Dellamonica, T Boulain, B Mourvillier, J Bailly Salin, M Wolff, J Charpentier, J D Chiche, S Ricome, B Megarbane, A Combes, M Schmidt, N Bréchot, J Chastre, H Rozé, A Ouattara, R Robert, E Carise, J Reignier, G Beduneau, J C M Richard, Y Le Tulzo, F Zeni, R Jospe, C Kummerlen, J P Gouello, C Cerf, J Devaquet, B Riu-Poulenc, A Luzi, B Georges, N Mayeur, E Mercier, A Guillon, M L Eustache

Affiliations

¹ Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. aryserpa@terra.com.br.
² Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. aryserpa@terra.com.br.
³ Faculdade de Medicina do ABC, Program of Post-Graduation, Research and Innovation, Santo André, Brazil. aryserpa@terra.com.br.
⁴ Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia.
⁵ Medical-Surgical Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (iCAN), Paris, France.
⁶ Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
⁷ Intensive Care Unit, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁸ Department of Anesthesia and Operative Intensive Care, Regensburg University Hospital, Regensburg, Germany.
⁹ Li Ka Shing Institute and Keenan Research Centre, St Michael's Hospital, Toronto, Canada.
¹⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹¹ INSERM U9555, Université Paris-Est, Créteil, France.
¹² Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
¹³ Service de Réanimation Médicale, Université Pierre et Marie Curie-Paris VI, Paris, France.
¹⁴ Intensive Care Department, Alfred Hospital, Melbourne, VIC, Australia.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
¹⁶ Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
¹⁷ Legacy Emanuel Medical Center, Portland, OR, USA.
¹⁸ Department of Emergency and Intensive Care, Faculty of Medicine, Centro Hospitalar Sao João, University of Porto, Porto, Portugal.
¹⁹ Department of Health Science, University of Milan-Bicocca, Monza, Italy.
²⁰ Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy.
²¹ Service de Réanimation Médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
²² UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA Team, Université Paris Diderot, Paris, France.
²³ UMR 915, Inserm, Université Paris Est Créteil, Créteil, France.
²⁴ Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University Göttingen, Göttingen, Germany.
²⁵ Department of Anaesthesia and Intensive Care Medicine, University of Rome "La Sapienza", Rome, Italy.
²⁶ Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
²⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
²⁸ Department of Intensive Care Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan.
²⁹ Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Sassari, University of Sassari, Sassari, Italy.
³⁰ Department of Anesthesia and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
³¹ Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany.
³² Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
³³ Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy.
³⁴ Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 27586996
PMCID: PMC7094949
DOI: 10.1007/s00134-016-4507-0

Meta-Analysis

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO

Ary Serpa Neto et al. Intensive Care Med. 2016 Nov.

. 2016 Nov;42(11):1672-1684.

doi: 10.1007/s00134-016-4507-0. Epub 2016 Sep 1.

Authors

Collaborators

ReVA Research Network and the PROVE Network Investigators:
E Zogheib, H Dupont, A Mercat, M Pierrot, G Capellier, B Verdiere, O Bastien, J J Lehot, J M Tonnelier, D Guelon, D du Cheyron, A Thille, T Pham, C Brun-Buisson, J P Quenot, Arasomoano, C Minet, J F Timsit, G Dessertaine, L Robriquet, E Jaillette, M Castanier, A Roch, L Papazian, J Eliet, P Gaudard, S Machado, K Kuteifan, A Kimmoun, B Levy, P Bizouarn, D Villiers, C Guitton, J Dellamonica, T Boulain, B Mourvillier, J Bailly Salin, M Wolff, J Charpentier, J D Chiche, S Ricome, B Megarbane, A Combes, M Schmidt, N Bréchot, J Chastre, H Rozé, A Ouattara, R Robert, E Carise, J Reignier, G Beduneau, J C M Richard, Y Le Tulzo, F Zeni, R Jospe, C Kummerlen, J P Gouello, C Cerf, J Devaquet, B Riu-Poulenc, A Luzi, B Georges, N Mayeur, E Mercier, A Guillon, M L Eustache

Affiliations

¹ Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. aryserpa@terra.com.br.
² Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. aryserpa@terra.com.br.
³ Faculdade de Medicina do ABC, Program of Post-Graduation, Research and Innovation, Santo André, Brazil. aryserpa@terra.com.br.
⁴ Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia.
⁵ Medical-Surgical Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (iCAN), Paris, France.
⁶ Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
⁷ Intensive Care Unit, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁸ Department of Anesthesia and Operative Intensive Care, Regensburg University Hospital, Regensburg, Germany.
⁹ Li Ka Shing Institute and Keenan Research Centre, St Michael's Hospital, Toronto, Canada.
¹⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹¹ INSERM U9555, Université Paris-Est, Créteil, France.
¹² Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
¹³ Service de Réanimation Médicale, Université Pierre et Marie Curie-Paris VI, Paris, France.
¹⁴ Intensive Care Department, Alfred Hospital, Melbourne, VIC, Australia.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
¹⁶ Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
¹⁷ Legacy Emanuel Medical Center, Portland, OR, USA.
¹⁸ Department of Emergency and Intensive Care, Faculty of Medicine, Centro Hospitalar Sao João, University of Porto, Porto, Portugal.
¹⁹ Department of Health Science, University of Milan-Bicocca, Monza, Italy.
²⁰ Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy.
²¹ Service de Réanimation Médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
²² UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA Team, Université Paris Diderot, Paris, France.
²³ UMR 915, Inserm, Université Paris Est Créteil, Créteil, France.
²⁴ Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University Göttingen, Göttingen, Germany.
²⁵ Department of Anaesthesia and Intensive Care Medicine, University of Rome "La Sapienza", Rome, Italy.
²⁶ Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
²⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
²⁸ Department of Intensive Care Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan.
²⁹ Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Sassari, University of Sassari, Sassari, Italy.
³⁰ Department of Anesthesia and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
³¹ Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany.
³² Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
³³ Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy.
³⁴ Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 27586996
PMCID: PMC7094949
DOI: 10.1007/s00134-016-4507-0

Abstract

Purpose: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients.

Methods: In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality.

Results: Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO₂/FiO₂, higher arterial pH and lower PaCO₂ levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)].

Conclusion: In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.

Keywords: ARDS; Driving pressure; ECMO; Mechanical ventilation; PEEP; Refractory hypoxemia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
(*Upper panel*) Cumulative incidence curve of in-hospital mortality; (*lower panel*) number of patients under mechanical ventilation (*orange line*), or ECMO (*blue line*)

**Fig. 2**
Tidal volume size (V _T), respiratory rate, inspired oxygen fractions (FiO₂), positive end-expiratory pressure (PEEP) levels, plateau pressure (Pplat) levels, and driving pressure (ΔP) in survivors (*orange line*) and non-survivors (*blue line*) during extracorporeal membrane oxygenation for the acute respiratory distress syndrome. *Before* before extracorporeal membrane oxygenation; days 1, 2 and 3, the first, second and third day of ECMO; data are presented as medians and their interquartile ranges, and only for patients that were still receiving ECMO

**Fig. 3**
PaO₂/FiO₂, PaCO₂ levels, pHa, and lactate levels in survivors (*orange line*) and non-survivors (*blue line*) during extracorporeal membrane oxygenation (ECMO) for the acute respiratory distress syndrome. *Before* before extracorporeal membrane oxygenation; days 1, 2 and 3, the first, second and third day of ECMO; data are presented as medians and their interquartile ranges, and only for patients that were still receiving ECMO

See this image and copyright information in PMC

Comment in

Novel Discoveries and Advances in Management of Acute Respiratory Distress Syndrome.
Ma KC, Jones DS, Price DR, Turetz ML. Ma KC, et al. Am J Respir Crit Care Med. 2017 May 1;195(9):1264-1266. doi: 10.1164/rccm.201612-2478RR. Am J Respir Crit Care Med. 2017. PMID: 28288286 No abstract available.

References

1. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334–1337. doi: 10.1056/NEJM200005043421806. - DOI - PubMed
1. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126–2136. doi: 10.1056/NEJMra1208707. - DOI - PubMed
1. ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–2533. - PubMed
1. The Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volume as compared with traditional tidal volume for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–1308. doi: 10.1056/NEJM200005043421801. - DOI - PubMed
1. Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303:865–873. doi: 10.1001/jama.2010.218. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO

Collaborators

Affiliations

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical