Réanimation

, Volume 22, Supplement 3, pp 633–642

Résultats de l’assistance respiratoire extracorporelle dans les syndromes de détresse respiratoire aiguë sévères

Référentiel / Guidelines
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Résumé

Des avancées majeures ont été réalisées dans la dernière décennie dans la conception des circuits d’extracorporeal membrane oxygenation (ECMO), et les résultats positifs de l’essai CESAR ont relancé l’intérêt pour la technique chez les malades présentant les formes les plus sévères de syndrome de détresse respiratoire aiguë (SDRA). Ces dispositifs ont également été utilisés avec succès lors de la pandémie grippale A(H1N1). Cependant, l’essai CESAR comporte de nombreuses limites méthodologiques, et les résultats des cohortes rétrospectives sont biaisés par la sélection initiale des malades qui ont reçu une ECMO. Avant une diffusion plus large de l’ECMO veinoveineuse pour les formes les plus sévères de SDRA, il apparaît souhaitable d’attendre les résultats d’essais randomisés en cours, dans lesquels l’ECMO est initiée précocement, les malades transférés rapidement sous ECMO vers un centre référent et la ventilation mécanique réglée en accord strict avec les recommandations internationales dans le groupe témoin.

Mots clés

Syndrome de détresse respiratoire aiguë Lésions liées à la ventilation Échanges gazeux 

Results of Extracorporeal Respiratory Support in the Severe Acute Respiratory Distress Syndrome

Abstract

Major technological improvements in extracorporeal membrane oxygenation (ECMO) machines and the positive results of the CESAR trial have reignited the interest for veno-venous (VV)-ECMO in patients with severe acute respiratory distress syndrome (ARDS) and persistent hypoxemia or hypercarbia on conventional mechanical ventilation. The technique has also been successfully used for the most severe ARDS cases associated with the recent Influenza A(H1N1) pandemic. However, since the CESAR study was criticized for methodological limitations and because results of non-randomized case-series of ECMO are prone to selection biases, indications for VV-ECMO use remain highly controversial. Before widespread diffusion of VV-ECMO for severe ARDS, new trials should test the efficacy of early initiation of the technique with tight control of mechanical ventilation in the control group, initiation of ECMO prior to transportation to ECMO centers, and the use of ECMO in every patient randomly assigned to receive it.

Keywords

Acute respiratory distress syndrome Ventilator-induced lung injury Gas exchange 

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Références

  1. 1.
    Hill JD, O’Brien TG, Murray JJ, et al (1972) Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 286:629–634PubMedCrossRefGoogle Scholar
  2. 2.
    Brodie D, Bacchetta M (2012) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–1914CrossRefGoogle Scholar
  3. 3.
    Combes A, Brechot N, Luyt CE, Schmidt M (2012) What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care 18:527–532PubMedCrossRefGoogle Scholar
  4. 4.
    Gattinoni L, Carlesso E, Langer T (2011) Clinical review: extracorporeal membrane oxygenation. Crit Care 15:243PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    MacLaren G, Combes A, Bartlett RH (2012) Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210–220PubMedCrossRefGoogle Scholar
  6. 6.
    Kolobow T, Zapol W, Pierce JE, et al (1968) Partial extracorporeal gas exchange in alert newborn lambs with a membrane artificial lung perfused via an A-V shunt for periods up to 96 hours. Trans Am Soc Artif Intern Organs 14:328–334PubMedGoogle Scholar
  7. 7.
    Brogan TV, Thiagarajan RR, Rycus PT, et al (2009) Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 35:2105–2114PubMedCrossRefGoogle Scholar
  8. 8.
    Mols G, Loop T, Geiger K, et al (2000) Extracorporeal membrane oxygenation: a ten-year experience. Am J Surg 180:144–154PubMedCrossRefGoogle Scholar
  9. 9.
    Bartlett RH (2000) Extracorporeal life support in the management of severe respiratory failure. Clin Chest Med 21:555–561PubMedCrossRefGoogle Scholar
  10. 10.
    Hemmila MR, Rowe SA, Boules TN, et al (2004) Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 240:595–605; discussion 605–597PubMedCentralPubMedGoogle Scholar
  11. 11.
    Lewandowski K, Rossaint R, Pappert D, et al (1997) High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med 23:819–835PubMedCrossRefGoogle Scholar
  12. 12.
    Beiderlinden M, Eikermann M, Boes T, et al (2006) Treatment of severe acute respiratory distress syndrome:role of extracorporeal gas exchange. Intensive Care Med 32:1627–1631PubMedCrossRefGoogle Scholar
  13. 13.
    Zapol WM, Snider MT, Hill JD, et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196PubMedCrossRefGoogle Scholar
  14. 14.
    Lindskov C, Jensen RH, Sprogoe P, et al (2013) Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure. Acta Anaesthesiol Scand 57:303–311PubMedCrossRefGoogle Scholar
  15. 15.
    Schmid C, Philipp A, Hilker M, et al (2012) Venovenous extracorporeal membrane oxygenation for acute lung failure in adults. J Heart Lung Transplant 31:9–15PubMedCrossRefGoogle Scholar
  16. 16.
    Hodgson CL, Hayes K, Everard T, et al (2012) Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. Crit Care 16:R202PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Schmidt M, Zogheib E, Roze H, et al (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after ECMO for severe ARDS. Intensive Care Med 39:1704–1713. doi: 10.1007/s00134-013-3037-2. Epub 2013 Aug 2PubMedCrossRefGoogle Scholar
  18. 18.
    The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009) Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA 302:1888–1895CrossRefGoogle Scholar
  19. 19.
    Noah MA, Peek GJ, Finney SJ, et al (2011) Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 306:1659–1668PubMedCrossRefGoogle Scholar
  20. 20.
    Pham T, Combes A, Roze H, et al (2013) Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1)-induced Acute Respiratory Distress Syndrome: A Cohort Study and Propensity-matched Analysis. Am J Respir Crit Care Med 187: 276–285PubMedCrossRefGoogle Scholar
  21. 21.
    Patroniti N, Zangrillo A, Pappalardo F, et al (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic:preparation for severe respiratory emergency outbreaks. Intensive Care Med 37:1447–1457PubMedCrossRefGoogle Scholar
  22. 22.
    Holzgraefe B, Broome M, Kalzen H, et al (2010) Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure. Minerva Anestesiol 76:1043–1051PubMedGoogle Scholar
  23. 23.
    Takeda S, Kotani T, Nakagawa S, et al (2012) Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) severe respiratory failure in Japan. Journal of anesthesia 26:650–657PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Bonastre J, Suberviola B, Pozo JC, et al (2012) Extracorporeal lung support in patients with severe respiratory failure secondary to the 2010-2011 winter seasonal outbreak of influenza A(H1N1) in Spain. Med Intensive 36:193–199CrossRefGoogle Scholar
  25. 25.
    Roch A, Lepaul-Ercole R, Grisoli D, et al (2010) Extracorporeal membrane oxygenation for severe influenza A(H1N1) acute respiratory distress syndrome: a prospective observational comparative study. Intensive Care Med 36:1899–1905PubMedCrossRefGoogle Scholar
  26. 26.
    NHS NICE GUIDANCE, last accessed July 31th 2013, http://www.nice.org.uk/nicemedia/live/11032/54274/54274.pdf
  27. 27.
    ECMOnet, last accessed July 31th 2013, http://www.ecmonet.org/index.php
  28. 28.
    NSW Critical Care Tertiary Referral Networks and Transfer of Care (ADULTS), last accessed July 31th 2013, http://www.health.nsw.gov.au/policies/
  29. 29.
    Freeman C, Bennett T, Hubbard A, et al (2012) Pediatric and Neonatal Extracorporeal Membrane Oxygenation; Does Center Volume Impact Mortality? Crit Care Med 40:1–328CrossRefGoogle Scholar
  30. 30.
    Jen HC, Shew SB (2010) Hospital readmissions and survival after nonneonatal pediatric ECMO. Pediatrics 125:1217–1223PubMedCrossRefGoogle Scholar
  31. 31.
    Karamlou T, Vafaeezadeh M, Parrish AM, et al (2013) Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients. J Thorac Cardiovasc Surg 145:470–475PubMedCrossRefGoogle Scholar
  32. 32.
    Beurtheret S, Mordant P, Paoletti X, et al (2013) Emergency circulatory support in refractory cardiogenic shock patients in remote institutions:a pilot study (the cardiac-RESCUE program). Eur Heart J 34:112–120PubMedCrossRefGoogle Scholar
  33. 33.
    Forrest P, Ratchford J, Burns B, et al (2011) Retrieval of critically ill adults using extracorporeal membrane oxygenation:an Australian experience. Intensive Care Med 37:824–830PubMedCrossRefGoogle Scholar
  34. 34.
    Linden V, Palmer K, Reinhard J, et al (2000) High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 26:1630–1637PubMedCrossRefGoogle Scholar
  35. 35.
    Peek GJ, Mugford M, Tiruvoipati R, et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363PubMedCrossRefGoogle Scholar
  36. 36.
    Schmidt M, Brechot N, Hariri S, et al (2012) Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 55:1633–1641PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Linden VB, Lidegran MK, Frisen G, et al (2009) ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life. Acta Anaesthesiol Scand 53:489–495PubMedCrossRefGoogle Scholar
  38. 38.
    Luyt CE, Combes A, Becquemin MH, et al (2012) Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe acute respiratory distress syndrome. Chest 142(3):583–592PubMedCrossRefGoogle Scholar
  39. 39.
    Herridge MS, Cheung AM, Tansey CM, et al (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693PubMedCrossRefGoogle Scholar
  40. 40.
    Schelling G, Stoll C, Haller M, et al (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMedCrossRefGoogle Scholar
  41. 41.
    Gattinoni L, Pesenti A, Mascheroni D, et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886PubMedCrossRefGoogle Scholar
  42. 42.
    Morris AH, Wallace CJ, Menlove RL, et al (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 149:295–305PubMedCrossRefGoogle Scholar
  43. 43.
    Iglesias M, Martinez E, Badia JR, Macchiarini P (2008) Extrapulmonary ventilation for unresponsive severe acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 85:237–244; discussion 244PubMedCrossRefGoogle Scholar
  44. 44.
    Bein T, Weber F, Philipp A, et al (2006) A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med 34:1372–1377PubMedCrossRefGoogle Scholar
  45. 45.
    Kluge S, Braune SA, Engel M, et al (2012) Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 38:1632–1639PubMedCrossRefGoogle Scholar
  46. 46.
    Burki NK, Mani RK, Herth FJ, et al (2013) A novel extracorporeal CO2 removal system:results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest 143:678–686PubMedCentralPubMedGoogle Scholar
  47. 47.
  48. 48.
    Guerin C, Reignier J, Richard JC, et al (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368: 2159–2168PubMedCrossRefGoogle Scholar

Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Service de réanimation médicale, groupe hospitalier Pitié-SalpêtrièreiCAN, Institute of Cardiometabolism and NutritionParis cedex 13France

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