20190614ECMO期间的机械通气设置

Participating ICUs and Patients Enrolled
Twenty-three ECMO centers from 10 countries participated in the study.
Participating ICUs and Patients Enrolled
Background
ECMO allows MV with very low TV, reduced Pplat and RR (6) thereby potentially minimizing VILI (7,8). However, ventilation strategies during ECMO have received little attention until now (9) and it is not clear how ECMO-treated ARDS patients are managed in routine practice in the broader international context, particularly with regard to MV settings and adjunctive therapies used before and after ECMO initiation. Data currently available in this area has been limited to selected retrospective cohorts (10, 11).
Background
The primary aim of the ventiLatIon management oF patients with Extracorporeal membrane oxyGenation for Acute Respiratory Distress Syndrome (LIFEGARDS) study was to describe the ventilatory management of ECMO-treated ARDS patients in medium to high case-volume international centers.
Mechanical ventilation management during ECMO for ARDS: An International Multicenter Prospective Cohort
Matthieu Schmidt1,2, Tài Pham3, Antonio Arcadipane 4, Cara Agerstrand 5, Shinichiro Ohshimo 6, Vincent Pellegrino7, Alain Vuylsteke8, Christophe Guervilly9; Shay McGuinness10, Sophie Pierard11, Jeff Breeding12; Claire Stewart13; Simon Sin Wai Ching14; Janice M Camuso15; R. Scott Stephens16; Bobby King17; Daniel Herr18 ; Marcus J Schultz19; Mathilde Neuville20; Elie Zogheib21; Jean-Paul Mira22; Hadrien Rozé23; Marc Pierrot24; Anthony Tobin25; Carol Hodgson726; Sylvie Chevret 27-28; Daniel Brodie*5 and Alain Combes*1,2; for the International ECMO Network (ECMONet), and the LIFEGARDS Study Group$
METHODS Study Design, Patients
LIFEGARDS was an international, multi-center, prospective cohort study conducted in 23 medium to high-volume ECMO ICUs across 10 countries. During a 12-month enrolment period (starting anywhere from September 2014 and January 2016), all consecutive patients over 15 years of age who received extracorporeal lung support (i.e., va- or vv- ECMO) for acute respiratory failure were prospectively screened. Exclusion criteria were ECMO cannulation performed at another center more than 48 hours before inclusion and retrieval to the enrolling center, end-stage chronic respiratory failure and inability to obtain informed consent to participate to this study, when required
Twenty-three ECMO centers from 10 countries participated in the study.ients Enrolled
Participating ICUs and Patients Enrolled
The secondary objective was to investigate the dynamic impact of mechanical ventilation and other organ failures on 6-month mortality. Lastly, we aimed to assess the use of adjunctive therapies before and during ECMO, and ECMOrelated complications.
Am J Respir Crit Care Med. 2019 May 30.
Background
Although its use remains controversial ECMO may be deployed in severe forms of ARDS to decrease the intensity of MV or as a rescue therapy for refractory ARDS. The largest randomized trial of ECMO for severe forms of ARDS failed to demonstrate a statistically significant difference in its pre-specified primary endpoint of 60-day mortality (4). However, the clinically important effect size seen in the EOLIA trial as well as the recent post-hoc Bayesian analysis (5) both suggest that ECMO is efficacious in some patients with severe forms of ARDS.
Results
Participating ICUs and Patients Enrolled Mechanical Ventilation management during ECMO Use of Adjunctive Measures Patient Outcomes and Predictors of 6-Month Mortality ECMO-related complications
PATIENTS AND METHODS Study Design and Oversight
The HELP-ECMO trial was a two-center, randomized,unblinded, parallel-group controlled trial comparing therapeutic anticoagulation with unfractionated heparin and a low-dose heparin protocol. The trial was conducted at two university-associated hospitals: the Alfred Hospital in Melbourne and the Royal Prince Alfred (RPA) Hospital in Sydney, Australia, for a period of 2 years. The ethics committees at both participating sites approved the protocol (Alfred 560/13, RPAX14-0312).
Participating ICUs and Patients Enrolled
Participating ICUs and Patients Enrolled
Mechanical Ventilation management during ECMO
Daily MV management was collected for a total of 4211 ECMO days. Before ECMO initiation, 50% of patients received volume-targeted modes of ventilation, whereas 40% were ventilated with pressure-targeted modes.