The ICM research agenda on extracorporeal life support

Combes, Alain; Brodie, D.; Chen, Yih‐Sharng; Fan, Eddy; Henriques, José P.S.; Hodgson, Carol; Lepper, Philipp M.; Leprince, Pascal; Maekawa, Kunihiko; Müller, Thomas; Nuding, Sebastian; Ouweneel, Dagmar M.; Roch, Antoine; Schmidt, Matthieu; Takayama, Hiroo; Vuylsteke, Alain; Werdan, Karl; Papazian, Laurent

doi:10.1007/s00134-017-4803-3

Cited by 96 publications

(83 citation statements)

References 80 publications

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“…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.…”

Section: Why a New Trial Now?mentioning

confidence: 99%

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

Bréchot

Schmidt

2017

Med Klin Intensivmed Notfmed

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Section: Why a New Trial Now?mentioning

confidence: 99%

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

Bréchot

Schmidt

2017

Med Klin Intensivmed Notfmed

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“…We therefore urgently need new high-quality data derived from adequately designed RCTs that will allow the least biased evaluation of the actual impact of extracorporeal gas exchange devices in ARDS patients [14]. The international multicenter randomized Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial (ClinicalTrials.…”

Section: Why Conduct New Rcts Of Extracorporeal Gas Exchange Now?mentioning

confidence: 99%

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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“…Extracorporeal membrane oxygenation (ECMO) or life support (ECLS) is increasingly used to provide life-saving cardiac or respiratory support for a variety of clinical conditions. [1][2][3] Veno-arterial (VA)-ECLS has gained a place in the management of refractory cardiac failure of various etiologies, with or without respiratory failure, of cardiac arrest, as temporary circulatory support or as a bridge-to-decision-making. [4][5][6][7] Despite its widespread use, many ECLS-related issues are still to be clarified.…”

Section: Introductionmentioning

confidence: 99%

A quantified description of the interactions between the native cardiovascular system and femoro‐femoral versus femoro‐axillary extracorporeal life support using descending thoracic aorta velocity time integral

et al. 2019

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Extracorporeal life support (ECLS) is an important tool in managing severe cardio‐circulatory and respiratory failures. The axillary and the femoral sites are the most frequently used for arterial cannulation. There is no current evidence favoring one site over the other. We tested the hypothesis that the axillary and femoral arterial cannulation site may have different effects on left ventricular (LV) outflow. Seven patients with femoro‐axillary ECLS and 4 patients with femoro‐femoral ECLS were prospectively studied using the Pulse‐wave Doppler (PWD) velocity time integral (VTI) in the descending thoracic aorta (DTA VTI) at different short‐time variations of ECLS flow rates during the ECLS weaning process. The measurements were safe and feasible in all patients. We found a directly proportional correlation between DTA VTI and ECLS flow rate for femoro‐axillary cannulation (P < 0.05) and an inversely proportional correlation in the case of femoro‐femoral cannulation (P < 0.05). This is the first reported utilization of DTA VTI during ECLS that could improve our understanding of the LV‐aorta interactions in patients with ECLS. DTA VTI could be used as a tool, guiding weaning from ECLS.

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The ICM research agenda on extracorporeal life support

Cited by 96 publications

References 80 publications

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

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

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

A quantified description of the interactions between the native cardiovascular system and femoro‐femoral versus femoro‐axillary extracorporeal life support using descending thoracic aorta velocity time integral

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