Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study

Kanji, Hussein D.; McCallum, Jessica; Norena, Monica; Wong, Hubert; Griesdale, Donald; Reynolds, Steven; Isac, George; Sirounis, Demetrios; Gunning, Derek; Finlayson, Gordon N.; Dodek, Peter

doi:10.1016/j.jcrc.2016.01.010

Cited by 12 publications

(9 citation statements)

References 28 publications

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“…Similarly, H1N1 patients who received ECMO in French ICUs of the REVA network [11] had better outcomes than their matched controls. Two more recent series [12,13], including patients suffering ARDS from various etiologies, also demonstrated better survival with ECMO after propensity-matching cases and controls. It should, however, be mentioned that the best propensity-matching technique will always be limited by residual confounding, that is, by unmatched selection and indication biases which lead clinicians to initiate ECMO in some patients and not in others.…”

Section: Trials and Case Series Of Extracorporeal Gas Exchange In Ardmentioning

confidence: 88%

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

Pesenti

Brodie

2017

Intensive Care Med

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Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases. Older trials are not relevant anymore since the ECMO circuitry was not heparin-coated leading to severe hemorrhagic complications due to high levels of anticoagulation, and because extracorporeal membrane oxygenation (ECMO) and control group patients did not receive lung-protective ventilation. Alternatively, in the more recent CESAR trial, many patients randomized to the ECMO arm did not receive ECMO and no standardized protocol for lung-protective mechanical ventilation existed in the control group. Since these techniques are costly and associated with potentially serious adverse events, there is an urgent need for high-quality data, for which the cornerstone remains randomized controlled trials.

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Section: Trials and Case Series Of Extracorporeal Gas Exchange In Ardmentioning

confidence: 88%

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

Pesenti

Brodie

2017

Intensive Care Med

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“…Most articles were excluded due to the absence of the survival analysis information and no stratification by the status of ECMO, resulting in 34 studies (Supplemental material S2). Then, with respect to respiratory failure in terms of 'oxygenation failure' and 'ventilation failure,' a total of five studies [27][28][29][30][31]were eligible for the final analysis of the ECMO mortality assessment.…”

Section: Resul T S Resul T S L I Te Ra Ture Se a Rch L I Te Ra Ture Smentioning

confidence: 99%

“…The length of follow-up ranged from 60 to 200 days. The proportion of ECMO recipients who received VV-ECMO was 100% in three studies [28][29][30], and 0% in one study [31]. We had difficulty determining the VV-ECMO proportion in one study [27]; nonetheless, its proportion, "84%," was taken from its meta-analysis [7].…”

Section: Study Cha Ra Cte Ri Sti Cs Study Cha Ra Cte Ri Sti Csmentioning

confidence: 99%

Extracorporeal membrane oxygenation meta-analysis of time-to-event data in respiratory failure in adults v1

Roh¹

2020

protocols.io

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Time-to-event data of hazard ratios were used to generate a forest plot of mortality on extracorporeal membrane oxygenation (ECMO) in respiratory failure in adults. Ma te ri a l s a nd Me thods: Ma te ri a l s a nd Me thods: A systemic search was conducted in PubMed from 1975 to 2018. Among 4,121 articles, a total of 5 clinical reports comprising 1,014patients (333 of the patients who underwent ECMO and 681 of the patients who did not undergo ECMO) met the inclusion criteria. Re sul ts: Re sul ts: The pooled hazard ratio of 0.64 (95% confidence interval (CI): 0.54, 0.76) suggests that the ECMO group comprising both veno-arterial (VA) type and a majority of veno-venous (VV) type was significantly associated with a reduction in mortality compared with the non-ECMO group in respiratory failure. The results of VV-ECMO alone also showed significantly improved patient survival of respiratory failure with the hazard ratio of 0.67 (0.56, 0.81). Concl usi ons: Concl usi ons: The results of the ECMO group with VV and VA types, or the VV type alone revealed a reduction in mortality for patients with respiratory failure based on time-to-event data.Future investigation of the efficacy of VA-ECMO alone in respiratory failure may be more enlightening.

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“…Use of the criteria in ARDS patients caused by influenza A (H1N1) virus showed a survival discharge rate of 68% [25]. In a well-matched cohort, early VV-ECMO was associated with lower mortality in patients with severe hypoxemic respiratory failure [26]. A threshold of plateau pressure is commonly used to avoid lung injury during mechanical ventilation.…”

Section: Timing Of Ecmo Initiation: Indications From Ventilation Pmentioning

confidence: 99%

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Zhang

Chen

et al. 2017

Canadian Respiratory Journal

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Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

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Early veno-venous extracorporeal membrane oxygenation is associated with lower mortality in patients who have severe hypoxemic respiratory failure: A retrospective multicenter cohort study

Cited by 12 publications

References 28 publications

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

Extracorporeal membrane oxygenation meta-analysis of time-to-event data in respiratory failure in adults v1

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

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