Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome An International Multicenter Prospective Cohort

Matthieu Schmidt , Tai Pham , Antonio Arcadipane , Cara Agerstrand , Shinichiro Ohshimo , Vincent Pellegrino , Alain Vuylsteke , Christophe Guervilly , Shay Mcguinness , Sophie Pierard , Jeff Breeding , Claire Stewart , Simon Sin Wai Ching , Janice M. Camuso , R. Scott Stephens , Bobby King , Daniel Herr , Marcus J. Schultz , Mathilde Neuville , Elie Zogheib , Jean-Paul Mira , Hadrien Roze , Marc Pierrot , Anthony Tobin , Carol Hodgson , Sylvie Chevret , Daniel Brodie , Alain Combes , Charles Edouard Luyt , Guillaume Lebreton , Pascal Leprince , Nicolas Brechot , Guillaume Franchineau , Ania Nieszkowska , Guillaume Hekimian , Gennaro Martucci , Matthew Bacchetta , Darryl Abrams , Madhavi Parekh , Anil Trindade , Yoshiko Kida , Michihito Kyo , Tatsutoshi Shimatani , Nobuaki Shime , Koichi Tanigawa , Kamen Valchanov , Jo-Anne Fowles , Louise Meagher , Laurent Papazian , Sami Hraiech , Jean Marie Forel , Rachael Parke , Lianne Mccarthy , Eileen Gilder , Alastair Mcgeorge , Luc-Marie Jacquet , Olivier van Caenegem , Priya Nair , Claire Reynolds , Paul Forrest , Chan Wai Ming , Harriet Kong , Matt Harmon , Lilia Bouadma , Jean Francois Timsit , Romain Sonneville , Herve Dupont (1, 2) , Joseph Nader (1) , Marion Wasilewski , David Gilles , Faouzi Trojette , Mona Moubarak , Thierry Caus (1, 2) , Espedito Faraone , Roger Smith

1 CHU Amiens-Picardie
2 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Rationale: Current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Objectives: To report current practices regarding mechanical ventilation in patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and their association with 6-month outcomes. Methods: This was an international, multicenter, prospective cohort study of patients undergoing ECMO for ARDS during a 1-year period in 23 international ICUs. Measurements and Main Results: We collected demographics, daily pre- and per-ECMO mechanical ventilation settings and use of adjunctive therapies, ICU, and 6-month outcome data for 350 patients (mean +/- SD pre-ECMO Pa-O2/FIO2 71 +/- 34 mm Hg). Pre-ECMO use of prone positioning and neuromuscular blockers were 26% and 62%, respectively. V-T (6.4 +/- 2.0 vs. 3.7 +/- 2.0 ml/kg), plateau pressure (32 +/- 7 vs. 24 +/- 7 cm H2O), driving pressure (20 +/- 7 vs. 14 +/- 4 cm H2O), respiratory rate (26 +/- 8 vs. 14 = 6 breaths/min), and mechanical power (26.1 +/- 12.7 vs. 6.6 +/- 4.8 J/min) were markedly reduced after ECMO initiation. Six-month survival was 61%. No association was found between ventilator settings during the first 2 days of ECMO and survival in multivariable analysis. A time-varying Cox model retained older age, higher fluid balance, higher lactate, and more need for renal-replacement therapy along the ECMO course as being independently associated with 6-month mortality. A higher VT and lower driving pressure (likely markers of static compliance improvement) across the ECMO course were also associated with better outcomes. Conclusions: Ultraprotective lung ventilation on ECMO was largely adopted across medium- to high-case volume ECMO centers. In contrast with previous observations, mechanical ventilation settings during ECMO did not impact patients' prognosis in this context.

Domaines: Sciences du Vivant [q-bio]

Matthieu Schmidt, Tai Pham, Antonio Arcadipane, Cara Agerstrand, Shinichiro Ohshimo, et al.. Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome An International Multicenter Prospective Cohort. American Journal of Respiratory and Critical Care Medicine, 2019, 200 (8), pp.1002-1012. ⟨10.1164/rccm.201806-1094OC⟩. ⟨hal-03572337⟩