Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study

Roch, Antoine; Lepaul-Ercole, Renaud; Grisoli, Dominique; Bessereau, Jacques; Brissy, Olivier; Castanier, Matthias; Dizier, Stéphanie; Forel, Jean-Marie; Guervilly, Christophe; Gariboldi, Vlad; Collart, Frédéric; Michelet, Pierre; Perrin, Gilles; Charrel, Rémi N.; Papazian, Laurent

doi:10.1007/s00134-010-2021-3

Cited by 120 publications

(113 citation statements)

References 14 publications

(24 reference statements)

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“…Reports from Australia and New Zealand [1] and from France [2] indicate that patients on ECMO were 34% and 50% of the mechanically ventilated patients, respectively. In Hong Kong [3] and Canada [4] only 6% of the patients were shifted from conventional ventilation to ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports describe cases of influenza A (H1N1)-associated acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) for severe hypoxemia refractory to conventional treatment [1][2][3][4][5][6]. However, uncertainty regarding the appropriate indication for ECMO in these patients still remains [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

et al. 2012

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This is an author version of the contribution published on:Questa è la versione dell'autore dell'opera: [Intensive Care Medicine,38(3),2012, doi: 10.1007/s00134-012-2490 The definitive version is available at: La versione definitiva è disponibile alla URL: [http://download.springer.com/static/pdf/687/art%253A10.1007%252Fs00 134-012-2490 Conclusions:Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system 1 (PPLAT RS ). In these patients, titrating PEEP on PPLAT RS may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to un-appropriate use of ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

et al. 2012

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“…Ten studies fulfilled the inclusion criteria, including four RCTs (19)(20)(21)(22) and six observational studies (14,(23)(24)(25)(26)(27). No SYSTEMATIC REVIEW SYSTEMATIC REVIEW pediatric trials met the inclusion criteria, and, therefore, only adult patients were included in all analyses.…”

Section: Literature Searchmentioning

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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“…In addition to enhanced technology, there is also a greater understanding of the nuances of patient management while on ECMO [5,6]. The recent CESAR trial results [7] and the favourable outcomes of patients who received ECMO as rescue therapy during the recent H1N1 influenza pandemic support this [8][9][10][11]. However, many uncertainties remain about the use of ECMO in the most severe ARDS patients.…”

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confidence: 99%

Outcomes and risk stratification for severe ARDS treated with ECMO

Papazian

Herridge

2013

Intensive Care Med

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The acute respiratory distress syndrome (ARDS) is associated with a high mortality rate despite recent encouraging results from RCTs [1][2][3]. Initial profound hypoxemia is associated with the highest mortality rate [4]. In the subset of patients with the most severe hypoxemia (PaO2/FiO2 ratio \50-70) and/or when there is a high risk of severe ventilator-induced lung injury related to increased plateau pressure, some centers propose extracorporeal membrane oxygenation (ECMO) to minimize the trauma caused by mechanical ventilation and to promote lung rest and recovery. Biotechnological developments in the ECMO circuit, catheter and pump design have reinvigorated enthusiasm about using ECMO more than 20 years after initial disappointing results. In addition to enhanced technology, there is also a greater understanding of the nuances of patient management while on ECMO [5,6]. The recent CESAR trial results [7] and the favourable outcomes of patients who received ECMO as rescue therapy during the recent H1N1 influenza pandemic support this [8][9][10][11]. However, many uncertainties remain about the use of ECMO in the most severe ARDS patients. We do not know at the present time if this intervention is able to decrease mortality compared to proning [1] or other ARDS-supportive treatments, nor do we understand specific morbidities related to catheter placement and prolonged circuit and anticoagulant exposure. Eligibility and selection criteria need to be informed by both mortality and morbidity outcome data, which are only just beginning to emerge [12,13]. The lung's ability to return to near-normal function after ARDS has been extensively reported [14]. We assume that pulmonary outcomes after ECMO will be similar, but what remains unclear are the other outcomes and in particular specific sequelae related to the application of this technology. As an example, placement of femoral cannulae may lead to ischemic nerve injury, and the resultant foot drop may have a profound impact on longer term function and mobility and other important patient and family-centered outcomes. These issues are of upmost importance because this intervention has very specific indications currently. First of all, ECMO is considered for the most hypoxemic patients. Although the relationship between hypoxemia and neurocognitive dysfunction was established by Hopkins and colleagues in 1999 [15], it remains unclear whether relatively brief hypoxemic exposures, for example, a PaO 2 /FiO 2 \50-70 for several hours or days, would create substantial neuropsychological injury to justify early application of ECMO and the potential for other important long-term and potentially irreversible physical disabilities. We need detailed knowledge of how the components of ECMO therapy interact with the premorbid health status of our

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Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study

Abstract: ECMO may be an effective salvage treatment for patients with influenza A (H1N1)-related ARDS presenting rapid refractory respiratory failure, particularly when provided by a mobile team allowing early cannulation prior to transfer to a reference centre.

Cited by 120 publications

References 14 publications

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

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

Outcomes and risk stratification for severe ARDS treated with ECMO

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