Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

被引：1546

作者：

Combes, A. ^{[1
,2
]}

Hajage, D. ^{[3
,4
]}

Capellier, G. ^{[11
,12
,13
]}

Demoule, A. ^{[5
,6
]}

Lavoue, S. ^{[14
]}

Guervilly, C. ^{[15
]}

Da Silva, D. ^{[16
]}

Zafrani, L. ^{[7
]}

Tirot, P. ^{[17
]}

Veber, B. ^{[18
]}

Maury, E. ^{[8
]}

Levy, B. ^{[21
,22
]}

Cohen, Y. ^{[23
]}

Richard, C. ^{[24
]}

Kalfon, P. ^{[25
]}

Bouadma, L. ^{[9
]}

Mehdaoui, H. ^{[26
]}

Beduneau, G. ^{[19
,20
]}

Lebreton, G. ^{[1
,10
]}

Brochard, L. ^{[28
,29
,30
]}

Ferguson, N. D. ^{[28
,29
,31
]}

Fan, E. ^{[28
,29
,31
]}

Slutsky, A. S. ^{[30
]}

Brodie, D. ^{[32
,33
]}

Mercat, A. ^{[27
]}

机构：

[1] Sorbonne Univ, INSERM, Unite Mixte Rech UMRS 1166, Inst Cardiometab & Nutr, Paris, France

[2] Hop La Pitie Salpetriere, AP HP, Inst Cardiol, Serv Med Intens Reanimat, Paris, France

[3] Hop La Pitie Salpetriere, AP HP, Ctr Pharmacoepidemiol, Sante Publ & Informat Med,Dept Biostat, Paris, France

[4] Sorbonne Univ, Unite Rech Clin Pitie Salpetriere, Paris, France

[5] Sorbonne Univ, INSERM, UMRS 1158, Paris, France

[6] Hop La Pitie Salpetriere, AP HP, Serv Med Intens Reanimat & Pneumol, Paris, France

[7] CHU St Louis, Serv Med Intens & Reanimat, Paris, France

[8] CHU St Antoine, Serv Med Intens & Reanimat, Paris, France

[9] Diderot Univ, Bichat Hosp, AP HP, Serv Med Intens & Reanimat, Paris, France

[10] Hop La Pitie Salpetriere, AP HP, Inst Cardiol, Serv Chirurg Thorac & Cardiovasc, Paris, France

[11] Univ Franche Comte, Besancon Univ Hosp, Serv Med Intens & Reanimat, Besancon, France

[12] Univ Franche Comte, Res Unit, Equipe Avenir 3920, Besancon, France

[13] Univ Franche Comte, Struct Federat Rech 4234, Besancon, France

[14] CHU Pontchaillou, Serv Med Intens & Reanimat, Rennes, France

[15] CHU Hop Nord, AP HM, Serv Med Intens & Reanimat, Marseille, France

[16] CHU St Denis, Serv Med Intens & Reanimat, St Denis, Reunion, France

[17] CHU Le Mans, Serv Med Intens & Reanimat, Le Mans, France

[18] CHU Rouen, Dept Anesthesie & Reanimat, Rouen, France

[19] Rouen Univ Hosp, Serv Med Intens & Reanimat, Rouen, France

[20] Univ Rouen, Normandie Univ, Equipe Avenir 3830, Rouen Univ Hosp, Rouen, France

[21] Univ Lorraine, CHU Nancy, Serv Med Intens & Reanimat, Nancy, France

[22] Univ Lorraine, INSERM Unite 1116, Nancy, France

[23] CHU Avicenne, Serv Med Intens & Reanimat, Bobigny, France

[24] CHU Kremlin Bicetre, Serv Med Intens & Reanima, Le Kremlin Bicetre, France

[25] Hop Chartres, Serv Reanimat Polyvalente, Chartres, France

[26] CHU Martinique, Fort De France, Martinique, France

[27] Univ Angers, Ctr Hosp Univ Angers, Serv Med Intens & Reanimat, Angers, France

[28] Univ Toronto, Interdepartmental Div Crit Care Med, Dept Med, Inst Hlth Management Policy & Evaluat, Toronto, ON, Canada

[29] Univ Toronto, Interdepartmental Div Crit Care Med, Dept Physiol, Inst Hlth Management Policy & Evaluat, Toronto, ON, Canada

[30] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada

[31] Univ Hlth Network & Sinai Hlth Syst, Toronto Gen Hosp, Dept Med, Div Respirol, Toronto, ON, Canada

[32] Columbia Univ, Med Ctr, Div Pulm Allergy & Crit Care Med, New York, NY USA

[33] Columbia Univ, New York Presbyterian Hosp, New York, NY USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2018年 / 378卷 / 21期

关键词：

2009 INFLUENZA A(H1N1); CLINICAL-TRIAL; LUNG INJURY; MORTALITY; EPIDEMIOLOGY; OUTCOMES; FAILURE; ARDS;

D O I：

10.1056/NEJMoa1800385

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao(2)) to the fraction of inspired oxygen (Fio(2)) of less than 50 mm Hg for more than 3 hours; a Pao(2):Fio(2) of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7.25 with a partial pressure of arterial carbon dioxide of at least 60 mm Hg for more than 6 hours - to receive immediate venovenous ECMO (ECMO group) or continued conventional treatment (control group). Crossover to ECMO was possible for patients in the control group who had refractory hypoxemia. The primary end point was mortality at 60 days. RESULTS At 60 days, 44 of 124 patients (35%) in the ECMO group and 57 of 125 (46%) in the control group had died (relative risk, 0.76; 95% confidence interval [CI], 0.55 to 1.04; P = 0.09). Crossover to ECMO occurred a mean (+/- SD) of 6.5 +/- 9.7 days after randomization in 35 patients (28%) in the control group, with 20 of these patients (57%) dying. The frequency of complications did not differ significantly between groups, except that there were more bleeding events leading to transfusion in the ECMO group than in the control group (in 46% vs. 28% of patients; absolute risk difference, 18 percentage points; 95% CI, 6 to 30) as well as more cases of severe thrombocytopenia (in 27% vs. 16%; absolute risk difference, 11 percentage points; 95% CI, 0 to 21) and fewer cases of ischemic stroke (in no patients vs. 5%; absolute risk difference, -5 percentage points; 95% CI, -10 to -2). CONCLUSIONS 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.

引用

页码：1965 / 1975

页数：11

共 22 条

[1] Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries [J].

Bellani, Giacomo ;

Laffey, John G. ;

Pham, Tai ;

Fan, Eddy ;

Brochard, Laurent ;

Esteban, Andres ;

Gattinoni, Luciano ;

van Haren, Frank ;

Larsson, Anders ;

McAuley, Daniel F. ;

Ranieri, Marco ;

Rubenfeld, Gordon ;

Thompson, B. Taylor ;

Wrigge, Hermann ;

Slutsky, Arthur S. ;

Pesenti, Antonio .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (08) :788-800

[2] THE AMERICAN-EUROPEAN CONSENSUS CONFERENCE ON ARDS - DEFINITIONS, MECHANISMS, RELEVANT OUTCOMES, AND CLINICAL-TRIAL COORDINATION [J].

BERNARD, GR ;

ARTIGAS, A ;

BRIGHAM, KL ;

CARLET, J ;

FALKE, K ;

HUDSON, L ;

LAMY, M ;

LEGALL, JR ;

MORRIS, A ;

SPRAGG, R ;

COCHIN, B ;

LANKEN, PN ;

LEEPER, KV ;

MARINI, J ;

MURRAY, JF ;

OPPENHEIMER, L ;

PESENTI, A ;

REID, L ;

RINALDO, J ;

VILLAR, J ;

VANASBECK, BS ;

DHAINAUT, JF ;

MANCEBO, J ;

MATTHAY, M ;

MEYRICK, B ;

PAYEN, D ;

PERRET, C ;

FOWLER, AA ;

SCHALLER, MD ;

HUDSON, LD ;

HYERS, T ;

KNAUS, W ;

MATTHAY, R ;

PINSKY, M ;

BONE, RC ;

BOSKEN, C ;

JOHANSON, WG ;

LEWANDOWSKI, K ;

REPINE, J ;

RODRIGUEZROISIN, R ;

ROUSSOS, C ;

ANTONELLI, MA ;

BELOUCIF, S ;

BIHARI, D ;

BURCHARDI, H ;

LEMAIRE, F ;

MONTRAVERS, P ;

PETTY, TL ;

ROBOTHAM, J ;

ZAPOL, W .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (03) :818-824

[3] Extracorporeal Membrane Oxygenation for ARDS in Adults [J].

Brodie, Daniel ;

Bacchetta, Matthew .

NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (20) :1905-1914

[4] Is Extracorporeal Circulation the Future of Acute Respiratory Distress Syndrome Management? [J].

Combes, Alain ;

Pesenti, Antonio ;

Ranieri, V. Marco .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2017, 195 (09) :1161-1170

[5] Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult Patients [J].

Combes, Alain ;

Brodie, Daniel ;

Bartlett, Robert ;

Brochard, Laurent ;

Brower, Roy ;

Conrad, Steve ;

De Backer, Daniel ;

Fan, Eddy ;

Ferguson, Niall ;

Fortenberry, James ;

Fraser, John ;

Gatiinoni, Luciano ;

Lynch, William ;

MacLaren, Graeme ;

Mercat, Alain ;

Mueller, Thomas ;

Ogino, Mark ;

Peek, Giles ;

Pellegrino, Vince ;

Pesenti, Antonio ;

Ranieri, Marco ;

Slutsky, Arthur ;

Vuylsteke, Alain .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2014, 190 (05) :488-496

[6] Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome [J].

Davies, Andrew ;

Jones, Daryl ;

Bailey, Michael ;

Beca, John ;

Bellomo, Rinaldo ;

Blackwell, Nikki ;

Forrest, Paul ;

Gattas, David ;

Granger, Emily ;

Herkes, Robert ;

Jackson, Andrew ;

McGuinness, Shay ;

Nair, Priya ;

Pellegrino, Vincent ;

Pettilae, Ville ;

Plunkett, Brian ;

Pye, Roger ;

Torzillo, Paul ;

Webb, Steve ;

Wilson, Michael ;

Ziegenfuss, Marc .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2009, 302 (17) :1888-1895

[7] Prone Positioning in Severe Acute Respiratory Distress Syndrome [J].

Guerin, Claude ;

Reignier, Jean ;

Richard, Jean-Christophe ;

Beuret, Pascal ;

Gacouin, Arnaud ;

Boulain, Thierry ;

Mercier, Emmanuelle ;

Badet, Michel ;

Mercat, Alain ;

Baudin, Olivier ;

Clavel, Marc ;

Chatellier, Delphine ;

Jaber, Samir ;

Rosselli, Sylvene ;

Mancebo, Jordi ;

Sirodot, Michel ;

Hilbert, Gilles ;

Bengler, Christian ;

Richecoeur, Jack ;

Gainnier, Marc ;

Bayle, Frederique ;

Bourdin, Gael ;

Leray, Veronique ;

Girard, Raphaele ;

Baboi, Loredana ;

Ayzac, Louis .

NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (23) :2159-2168

[8] Should We "Rescue" Patients With 2009 Influenza A(H1N1) and Lung Injury From Conventional Mechanical Ventilation? [J].

Hubmayr, Rolf D. ;

Farmer, J. Christopher .

CHEST, 2010, 137 (04) :745-747

[9] Methods for Adjusting for Bias Due to Crossover in Oncology Trials [J].

Ishak, K. Jack ;

Proskorovsky, Irina ;

Korytowsky, Beata ;

Sandin, Rickard ;

Faivre, Sandrine ;

Valle, Juan .

PHARMACOECONOMICS, 2014, 32 (06) :533-546

[10] Extracorporeal membrane oxygenation: evolving epidemiology and mortality [J].

Karagiannidis, Christian ;

Brodie, Daniel ;

Strassmann, Stephan ;

Stoelben, Erich ;

Philipp, Alois ;

Bein, Thomas ;

Mueller, Thomas ;

Windisch, Wolfram .

INTENSIVE CARE MEDICINE, 2016, 42 (05) :889-896

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