Extracorporeal Membrane Oxygenation Rescue for H1N1 Acute Respiratory Distress Syndrome

Cooper, Jamie; Hodgson, Carol

doi:10.1164/rccm.201211-2052ed

Cited by 14 publications

(10 citation statements)

References 8 publications

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“…The recently completed Conventional ventilatory support versus Extracorporeal membrane oxygenation for Severe Adult Respiratory failure (CESAR) trial and a systematic review of ECLS for the H1N1 cohort further strengthened its potential role as rescue therapy in ARDS (12,13). However, poor outcomes from historical trials and conflicting results from recent reports have tempered the recent enthusiasm for its use and have reestablished clinical equipoise for ECLS in patients with ARDS (14,15).…”

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confidence: 99%

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

et al. 2014

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Rationale: Extracorporeal life support (ECLS) for acute respiratory failure has increased as a result of technological advancements and promising results from recent studies as compared with historical trials.Objectives: Systematically review the effect of ECLS compared with mechanical ventilation on mortality, length of stay, and adverse events in respiratory failure.Methods: Data sources included were MEDLINE, EMBASE, and CENTRAL (through to October 2013). Any randomized controlled trial (RCT) or observational study comparing ECLS to mechanical ventilation in adults was used. Two authors independently abstracted the data. Our primary outcome was mortality. Secondary outcomes included intensive care unit length of stay, hospital length of stay, and adverse events. A sensitivity analysis was performed restricted to RCTs and quasi-RCTs, and a number of predefined subgroups were identified to explore heterogeneity. Measurements and Main Results:Ten studies (four RCTs, six observational studies, 1,248 patients) were included. There was no significant difference in hospital mortality with ECLS as compared with mechanical ventilation (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.79-1.33; I 2 = 77%). When restricted to venovenous ECLS studies of randomized trials and quasi-randomized trials (three studies; 504 patients), there was a decrease in mortality with ECLS compared with mechanical ventilation (RR, 0.64; 95% CI, 0.51-0.79; I 2 = 15%). There were insufficient study-level data to evaluate most secondary outcomes. Bleeding was significantly greater in the ECLS group (RR, 11.44; 95% CI, 3.11-42.06; I 2 = 0%). In the H1N1 subgroup (three studies; 364 patients), ECLS was associated with significantly lower hospital mortality (RR, 0.62; 95% CI, 0.45-0.8; I 2 = 25%).Conclusions: ECLS was not associated with a mortality benefit in patients with acute respiratory failure. However, a significant mortality benefit was seen when restricted to higher-quality studies of venovenous ECLS. Patients with H1N1-acute respiratory distress syndrome represent a subgroup that may benefit from ECLS. Future studies are needed to confirm the efficacy of ECLS as well as the optimal configuration, indications, and timing for adult patients with respiratory failure.

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confidence: 99%

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

et al. 2014

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“…Первоначальные результаты применения ЭКМО были неутешительными [78,79], но затем методика экстракорпоральной поддержки была улучшена и в последние годы после обнадеживающих результатов, полученных во время пандемии гриппа A/H1N1 (2009) [80][81][82], широко применяется во многих странах. Несмотря на рост применения ВВ ЭКМО у больных с ОРДС [83], доказательства эффективности этой методики ограничены, особенно при тяжелом ОРДС [79,84]. Резюме доказательств.…”

Section: клиническая проблема 6 показана ли пациентам с острым респиunclassified

Mechanical Ventilation in Adults with Acute Respiratory Distress Syndrome An Official Clinical Guideline of American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine

Fan¹,

Sorbo²,

Goligher³

et al. 2018

Pulʹmonologiâ (Mosk.)

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Adopted from: Fan E., Del Sorbo L., Goligher E.C., Hodgson C.L., Munshi L., Walkey A.J., Adhikari N.K.J., Amato M.B.P., Branson R., Brower R.G., Ferguson N.D., Gajic O., Gattinoni L., Hess D., Mancebo J., Meade M.O., McAuley D.F., Pesenti A., Ranieri V.M., Rubenfeld G.D., Rubin E., Seckel M., Slutsky A.S., Talmor D., Thompson B. T., Wunsch H., Uleryk E., Brozek J., Brochard L.J. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 2017; 195 (9): 1253–1263. DOI: 10.1164/rccm.201703-0548STThe aim of this guideline is to provide clinical recommendation on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS).Methods. This guideline is based on systematic review and metaanalysis of available literature on the use of mechanical ventilation in adult patients with ARDS.Results. All patients with ARDS should be mechanically ventilated with the use of lower tidal volumes (4–8 ml/kg predicted bodyweight) and lower inspiratory pressures (plateau pressure, 30 cm H2O). In severe ARDS, the prone positioning for more than 12 h/d is strongly recommended. In patients with moderate to severe ARDS, routine use of high-frequency oscillatory ventilation is not recommended; a conditional recommendation has been developed for the use of higher positive end-expiratory pressure and recruitment maneuvers. CuОР – ently, there is not enough evidence for the use of extracorporeal membrane oxygenation in patients with severe ARDS.Conclusions. Practical recommendations on selected methods to coОР – ect ventilation disturbances in adult patients with ARDS have been developed. Clinicians involved in the management of patients with ARDS should use personalized approach to the treatment of these patients.

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“…Noah and colleagues compared patients referred for ECMO support to four specialized centers in the UK to those with suspected or confirmed H1N1 from a prospective cohort (the Swine Flu Triage Study) and found that the risk of death was approximately 50% lower in those referred for ECMO, irrespective of three different statistical matching approaches (28). In a larger registry of patients with influenza A from France (the REVA/ French Society of Intensive Care [SRLF] H1N1 registry), there was no difference in outcomes for those who received ECMO as compared with those who did not receive ECMO with severe ARDS when individuals were matched one-to-one, although 50% of the ECMO-treated patients went unmatched, and mortality was lower in this group as compared with matched patients receiving ECMO (12,29). Survival in an H1N1 cohort from Utah (n = 47) not treated with rescue therapies was on par with reports in which ECMO was used (83%), highlighting the uncertainty that remains about the role of this therapy (and other rescue modalities) in patients with severe respiratory failure (8,9,12).…”

Section: Hypoxemic Respiratory Failure Ards and The H1n1 Experiencementioning

confidence: 99%

Extracorporeal Life Support in Critically Ill Adults

Ventetuolo

Muratore

2014

Am J Respir Crit Care Med

116

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Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome that characterized the 2009 influenza A(H1N1) pandemic have stimulated renewed interest in the use of venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to support the respiratory system. Theoretical advantages of ECLS for respiratory failure include the ability to rest the lungs by avoiding injurious mechanical ventilator settings and the potential to facilitate early mobilization, which may be advantageous for bridging to recovery or to lung transplantation. The use of venoarterial ECMO has been expanded and applied to critically ill adults with hemodynamic compromise from a variety of etiologies, beyond postcardiotomy failure. Although technology and general care of the ECLS patient have evolved, ECLS is not without potentially serious complications and remains unproven as a treatment modality. The therapy is now being tested in clinical trials, although numerous questions remain about the application of ECLS and its impact on outcomes in critically ill adults.

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Extracorporeal Membrane Oxygenation Rescue for H1N1 Acute Respiratory Distress Syndrome

Cited by 14 publications

References 8 publications

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

Extracorporeal Life Support for Acute Respiratory Failure. A Systematic Review and Metaanalysis

Mechanical Ventilation in Adults with Acute Respiratory Distress Syndrome An Official Clinical Guideline of American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine

Extracorporeal Life Support in Critically Ill Adults

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