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Intensive Care Medicine

, Volume 42, Issue 11, pp 1672–1684 | Cite as

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis

Mechanical ventilation during ECMO
  • Ary Serpa NetoEmail author
  • Matthieu Schmidt
  • Luciano C. P. Azevedo
  • Thomas Bein
  • Laurent Brochard
  • Gernot Beutel
  • Alain Combes
  • Eduardo L. V. Costa
  • Carol Hodgson
  • Christian Lindskov
  • Matthias Lubnow
  • Catherina Lueck
  • Andrew J. Michaels
  • Jose-Artur Paiva
  • Marcelo Park
  • Antonio Pesenti
  • Tài Pham
  • Michael Quintel
  • V. Marco Ranieri
  • Michael Ried
  • Roberto Roncon-AlbuquerqueJr
  • Arthur S. Slutsky
  • Shinhiro Takeda
  • Pier Paolo Terragni
  • Marie Vejen
  • Steffen Weber-Carstens
  • Tobias Welte
  • Marcelo Gama de Abreu
  • Paolo Pelosi
  • Marcus J. Schultz
  • The ReVA Research Network and the PROVE Network Investigators
Original

Abstract

Purpose

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients.

Methods

In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality.

Results

Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure − PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO2, higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03–1.10)].

Conclusion

In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.

Keywords

Mechanical ventilation ARDS Refractory hypoxemia ECMO PEEP Driving pressure 

Notes

Acknowledgments

The authors are grateful to the REVA Research Network; Committee of Crisis Control, the Japanese Society of Respiratory Care Medicine and Committee of Pandemic H1N1 Surveillance, the Japanese Society of Intensive Care Medicine; and the Australian and New Zealand Intensive Care Society (ANZICS) for their help with the data from ECMO cases. They thank all the medical and nursing staff of participating centres. Collaborators (REVA Research Network) are as follows:

ECMO centers (CHU University Hospital, CH non-university hospital): CHU d’Amiens: E. Zogheib, H. Dupont; CHU d’Angers: A. Mercat, M. Pierrot; CHU J. Minjoz, Besançon: G. Capellier; CHU L. Pradel, Bron: B. Verdiere, O. Bastien, J.-J. Lehot; CHU de Brest: J.M. Tonnelier; CHU Clermont- Ferrand: D. Guelon; CHU Côte de Nacre, Caen: D. du Cheyron; CHU Henri Mondor, Créteil: A. Thille, T. Pham, C. Brun-Buisson; CHU Dijon: JP Quenot; CHU A. Michallon, Grenoble (Medical ICU): Arasomoano, C. Minet, J.-F. Timsit; CHU A. Michallon, Grenoble (Surgical ICU): G. Dessertaine; CHU de Lille: L. Robriquet, E. Jaillette; CHU Marseille: M. Castanier, A. Roch, L. Papazian; CHU Arnaud de Villeneuve, Montpellier: J. Eliet, P. Gaudard, S. Machado; CHG Emile Muller, Mulhouse: K. Kuteifan; CHU Nancy: A. Kimmoun, B. Levy; CHU Nantes: P. Bizouarn, D. Villiers, C. Guitton; CHU Archet 1, Nice: J. Dellamonica; CHR Orléans: T. Boulain; CHU Bichat Claude Bernard, Paris: B. Mourvillier, J. Bailly Salin, M. Wolff; CHU Cochin, Paris: J. Charpentier, J.-D. Chiche, S. Ricome; CHU Lariboisière, Paris: B. Megarbane; CHU Pitié Salpetrière, Paris: A. Combes, M. Schmidt, N. Bréchot, J. Chastre; CHU Haut Lévêque, Pessac: H. Rozé, A. Ouattara; CHU Poitiers: R. Robert, E. Carise; CHD Les Oudaries, La Roche s/Yon: J. Reignier; CHU Charles Nicolle, Rouen: G. Beduneau, J.-C.M. Richard; CHU Pontchaillou, Rennes: Y. Le Tulzo; CHU St Etienne: F. Zeni, R. Jospe; CHU de Strasbourg: C. Kummerlen, J.P. Gouello; Hôpital Foch, Suresnes: C. Cerf, J. Devaquet; CHU Purpan, Toulouse: B. Riu-Poulenc, A. Luzi; CHU Rangueil, Toulouse: B. Georges, N. Mayeur; CHU Bretonneau, Tours: E. Mercier, A. Guillon; CH Bretagne atlantique, Vannes: M.L. Eustache.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2016_4507_MOESM1_ESM.docx (795 kb)
Supplementary material 1 (DOCX 795 kb)
134_2016_4507_MOESM2_ESM.docx (28 kb)
Supplementary material 2 (DOCX 28 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Ary Serpa Neto
    • 1
    • 2
    • 3
    Email author
  • Matthieu Schmidt
    • 4
    • 5
  • Luciano C. P. Azevedo
    • 6
    • 7
  • Thomas Bein
    • 8
  • Laurent Brochard
    • 9
    • 10
    • 11
  • Gernot Beutel
    • 12
  • Alain Combes
    • 5
    • 13
  • Eduardo L. V. Costa
    • 6
    • 7
  • Carol Hodgson
    • 4
    • 14
  • Christian Lindskov
    • 15
  • Matthias Lubnow
    • 16
  • Catherina Lueck
    • 12
  • Andrew J. Michaels
    • 17
  • Jose-Artur Paiva
    • 18
  • Marcelo Park
    • 6
    • 7
  • Antonio Pesenti
    • 19
    • 20
  • Tài Pham
    • 21
    • 22
    • 23
  • Michael Quintel
    • 24
  • V. Marco Ranieri
    • 25
  • Michael Ried
    • 26
  • Roberto Roncon-AlbuquerqueJr
    • 18
  • Arthur S. Slutsky
    • 27
  • Shinhiro Takeda
    • 28
  • Pier Paolo Terragni
    • 29
  • Marie Vejen
    • 15
  • Steffen Weber-Carstens
    • 30
  • Tobias Welte
    • 31
  • Marcelo Gama de Abreu
    • 32
  • Paolo Pelosi
    • 33
  • Marcus J. Schultz
    • 1
    • 34
  • The ReVA Research Network and the PROVE Network Investigators
  1. 1.Department of Intensive Care, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Critical Care MedicineHospital Israelita Albert EinsteinSão PauloBrazil
  3. 3.Faculdade de Medicina do ABCProgram of Post-Graduation, Research and InnovationSanto AndréBrazil
  4. 4.Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research CentreSchool of Public Health, Monash UniversityMelbourneAustralia
  5. 5.Medical-Surgical Intensive Care UnitHôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (iCAN)ParisFrance
  6. 6.Research and Education Institute, Hospital Sírio-LibanêsSão PauloBrazil
  7. 7.Intensive Care Unit, Emergency Medicine DepartmentHospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
  8. 8.Department of Anesthesia and Operative Intensive CareRegensburg University HospitalRegensburgGermany
  9. 9.Li Ka Shing Institute and Keenan Research Centre, St Michael’s HospitalTorontoCanada
  10. 10.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  11. 11.INSERM U9555, Université Paris-EstCréteilFrance
  12. 12.Department of Hematology, Hemostasis, Oncology, and Stem Cell TransplantationHannover Medical SchoolHannoverGermany
  13. 13.Service de Réanimation MédicaleUniversité Pierre et Marie Curie-Paris VIParisFrance
  14. 14.Intensive Care DepartmentAlfred HospitalMelbourneAustralia
  15. 15.Department of Anaesthesiology and Intensive Care MedicineAarhus University HospitalAarhus NDenmark
  16. 16.Department of Internal Medicine IIUniversity Hospital RegensburgRegensburgGermany
  17. 17.Legacy Emanuel Medical CenterPortlandUSA
  18. 18.Department of Emergency and Intensive Care, Faculty of MedicineCentro Hospitalar Sao João, University of PortoPortoPortugal
  19. 19.Department of Health ScienceUniversity of Milan-BicoccaMonzaItaly
  20. 20.Department of Emergency MedicineSan Gerardo HospitalMonzaItaly
  21. 21.Service de Réanimation MédicaleGroupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de ParisCréteilFrance
  22. 22.UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA TeamUniversité Paris DiderotParisFrance
  23. 23.UMR 915, InsermUniversité Paris Est CréteilCréteilFrance
  24. 24.Department of Anaesthesiology, Emergency and Intensive Care MedicineUniversity Medicine, Georg-August-University GöttingenGöttingenGermany
  25. 25.Department of Anaesthesia and Intensive Care MedicineUniversity of Rome “La Sapienza”RomeItaly
  26. 26.Department of Thoracic SurgeryUniversity Medical Center RegensburgRegensburgGermany
  27. 27.Interdepartmental Division of Critical Care MedicineUniversity of Toronto; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  28. 28.Department of Intensive Care MedicineKawaguchi Cardiovascular and Respiratory HospitalKawaguchiJapan
  29. 29.Department of Surgical Sciences, Anaesthesiology and Intensive Care MedicineAzienda Ospedaliero-Universitaria Sassari, University of SassariSassariItaly
  30. 30.Department of Anesthesia and Operative Intensive Care MedicineCharité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité MitteBerlinGermany
  31. 31.Department of Pulmonary MedicineGerman Centre for Lung Research, Hannover Medical SchoolHannoverGermany
  32. 32.Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Carl Gustav Carus, Technische Universität DresdenDresdenGermany
  33. 33.Department of Surgical Sciences and Integrated DiagnosticsIRCCS AOU San Martino IST, University of GenoaGenoaItaly
  34. 34.Laboratory of Experimental Intensive Care and AnesthesiologyAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands

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