Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort

Matthieu Schmidt^{1

2}, Tài Pham^{3

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 Neuville^{21

22}, Elie Zogheib^{23

24}, Jean-Paul Mira^{25

26

27}, Hadrien Rozé²⁸, Marc Pierrot²⁹, Anthony Tobin³⁰, Carol Hodgson^{8

31}, Sylvie Chevret^{32

33}, Daniel Brodie⁶, Alain Combes^{1

2}

Affiliations

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.

PMID: 31144997
DOI: 10.1164/rccm.201806-1094OC

Multicenter Study

Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort

Matthieu Schmidt et al. Am J Respir Crit Care Med. 2019.

. 2019 Oct 15;200(8):1002-1012.

doi: 10.1164/rccm.201806-1094OC.

Authors

Affiliations

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.

PMID: 31144997
DOI: 10.1164/rccm.201806-1094OC

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 Pa_O₂/Fi_O₂ 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.

Keywords: ECMO; acute respiratory distress syndrome; mechanical ventilation; outcome; prone position.

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Breathing and Ventilation during Extracorporeal Membrane Oxygenation: How to Find the Balance between Rest and Load.
Quintel M, Busana M, Gattinoni L. Quintel M, et al. Am J Respir Crit Care Med. 2019 Oct 15;200(8):954-956. doi: 10.1164/rccm.201906-1164ED. Am J Respir Crit Care Med. 2019. PMID: 31216180 Free PMC article. No abstract available.

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Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort

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Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort

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Abstract

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