Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

Abstract

Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .).

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

“…In addition, early ECMO implantation for severe ARDS not responding rapidly to adjunctive therapies allows earlier rest for the lungs, significantly minimizes mechanical ventilation-induced trauma, and thereby prevents disease progression towards destructive fibrosis [21]. In light of all these observations and the advances made in ECMO technology, it appeared necessary to undertake a new trial, optimizing the therapies to be administered in the ECMO arm as well as in the conventional treatment arm [22][23][24]. For the ECMO arm, it was essential to implant the system as rapidly as possible, once the patient met the trial's inclusion criteria, before inflammatory lesions, signs of ARDS progression towards fibrosis, are established and definitively destroy the pulmonary parenchyma.…”

Do we need randomized clinical trials in extracorporeal respiratory support? No

“…The EOLIA trial [10] was designed to find a 20% absolute mortality difference between ECMO and control group. For the trial to be "positive" it is necessary that the fraction of mortality due to VILI is 20%, that VILI completely disappears in the ECMO group, and that the mortality attributable to ECMO is 0%.…”

Persistent hypoxemia during extracorporeal membrane oxygenation in delayed diagnosed paraquat intoxication

“…Hypoxia, which occurs secondary to many diseases, is a common sign in critically ill patients. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) in acute respiratory distress syndrome (ARDS) is currently a widely used therapeutic strategy (3,4). In this treatment, blood is drained from the superior or inferior vena cava and reinfused into the right atrium.…”

“…Artificial lung membrane adequately removes blood carbon dioxide and provides oxygenation (3). It allows use of protective mechanical ventilation strategy and reduces risk of barotrauma, volutrauma, ventilator-induced lung injury, or oxygen toxicity (3,4). In some patients, however, extracorporeal support fails to restore arterial oxygenation (5).…”