Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study
American Journal of Respiratory and Critical Care Medicine, vol. 212, pp. 2187–2198
Abstract
RATIONALE: In acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) without invasive mechanical ventilation (IMV) is particularly challenging. OBJECTIVES: To study ARDS patients treated with ECMO to avoid IMV (primary awake ECMO) or with extubation during ECMO support (extubated ECMO). METHODS: International retrospective cohort of adult ARDS patients treated with ECMO without IMV at 14 centers in 8 countries (2015-2024). The primary outcome was mortality 90 days after ECMO initiation. MEASUREMENTS AND MAIN RESULTS: Among 307 adult patients with ARDS, 113 received primary awake ECMO, and 194 were extubated on ECMO. Ninety-day mortality was 30.1% in the primary awake ECMO group and 14.9% in the extubated ECMO. Strategy failure occurred in 46 (40.7%) patients and 47 (24.2%) patients, respectively, most frequently within the first 10 days. In multivariate analysis, strategy failure was associated with 90-day mortality (hazard ratio [HR] = 7.67; 95% CI, 3.44-17.11; P < .001 in extubated ECMO; HR = 5.95; 95% CI, 2.63-13.46; P < .001 in primary awake ECMO), while higher age and longer time from ICU admission to ECMO cannulation were associated with 90-day mortality in extubated ECMO and primary awake ECMO, respectively. The leading cause of strategy failure was worsening of respiratory failure, followed by agitation/delirium in primary awake ECMO and inability to clear secretions in extubated ECMO. CONCLUSIONS: Patients selected for primary awake ECMO and extubated ECMO presented different baseline characteristics, strategy failure, and 90-day mortality rates. However, strategy failure was consistently associated with 90-day mortality in both groups.
Authors 58
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Universidade do Porto · Hospital de São João
Affiliation as printed
Department of Intensive Care Medicine, São João University Hospital , Porto,
Department of Physiology and Surgery, Faculty of Medicine, University of Porto , Porto,
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Inserm · Université de Versailles Saint-Quentin-en-Yvelines · Centre de recherche en Epidémiologie et Santé des Populations · Hôpital Marie Lannelongue
Affiliation as printed
Intensive Care Unit, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, Inserm U1018, CESP, University Versailles Saint Quentin—University Paris Saclay , Guyancourt,
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Affiliation as printed
Department of Intensive Care Medicine, São João University Hospital , Porto,
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Affiliation as printed
Department of Intensive Care Medicine, São João University Hospital , Porto,
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Affiliation as printed
Department of Internal Medicine V (Pneumology, Allergology and Intensive Care Medicine), Saarland University , Homburg,
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Hospital de Santa Maria · Unidade Local de Saúde Santa Maria
Affiliation as printed
Intensive Care Medicine Department, Santa Maria Local Health Unit , Lisbon,
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Micha Landoll Aachen Department of Cardiovascular Engineering Institute of Applied Medical Engineering Medical Faculty Institute for Computational Biomedicine
Witten/Herdecke University · RWTH Aachen University
Affiliation as printed
Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University , Aachen,
Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, University Witten/Herdecke , Cologne,
Institute for Computational Biomedicine, Medical Faculty, RWTH Aachen University , Aachen,
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Affiliation as printed
Intensive Care Unit, ECMO Reference Center, São José Local Health Unit , Lisbon,
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University Hospital Regensburg
Affiliation as printed
Department of Internal Medicine II, University Hospital Regensburg ,
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Medizinische Hochschule Hannover · German Center for Lung Research
Affiliation as printed
German Center for Lung Research (DZL), Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH) , Hannover,
Hannover Medical School, Respiratory Medicine and Infectious Diseases , Hannover,
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Affiliation as printed
Cardiac ICU, Hospital Mater Dei/ECMO Minas , Belo Horizonte,
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Comprehensive Cancer Center Vienna · Medical University of Vienna
Affiliation as printed
Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care (CEMIC), Medical University of Vienna , Vienna,
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University of Milan · Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Department of Emergency, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan,
University of Milan , Milan,
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Ministry of Interior and Administration · National Medical Institute of the Ministry of Interior and Administration
Affiliation as printed
Anesthesiology and Intensive Care, National Institute of Medicine of the Ministry of Interior and Administration in Warsaw , Warsaw,
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Affiliation as printed
Critical Care Department, Alvaro Cunqueiro Hospital , Vigo,
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Centre Hospitalier Universitaire de Besançon · Université de Franche-Comté
Affiliation as printed
Medical Intensive Care Unit, Besançon University Hospital , Besançon,
University of Franche-Comté , Besançon,
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Universidade do Porto · Hospital de São João
Affiliation as printed
Department of Intensive Care Medicine, São João University Hospital , Porto,
Department of Medicine, Faculty of Medicine, University of Porto , Porto,
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Inserm · Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital · Fondation pour l’innovation en Cadiométabolisme et Nutrition
Affiliation as printed
Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN , Paris,
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–Salpêtrière , Paris,
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Affiliation as printed
Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, University Witten/Herdecke , Cologne,
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Matthieu Schmidt corresponding
Inserm · Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital · Fondation pour l’innovation en Cadiométabolisme et Nutrition
Affiliation as printed
Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN , Paris,
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–Salpêtrière , Paris,
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