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Cited by 2,380Respiratory Support and MechanismsMechanical Circulatory Support DevicesNeonatal Respiratory Health Research

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

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Combes, Alain, Hajage, David, Capellier, Gilles, Demoule, Alexandre, Lavoué, Sylvain, Guervilly, Christophe, Da Silva, Daniel, Zafrani, Lara +17 more·2018·New England Journal of Medicine
DOI 10.1056/nejmoa1800385
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Abstract

BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: 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. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .).

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  • The evidence for the use of VV-ECMO in sepsis-induced ARDS is limited, with two RCTs completed in the last 10 years to assess the potential efficacy of VV ECMO for severe ARDS.

    “The evidence for the use of VV-ECMO in sepsis-induced ARDS is limited, with two RCTs completed in the last 10 years to assess the potential efficacy of VV ECMO for severe ARDS [476, 477].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [476]

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Authors
Combes, A., Hajage, D., Capellier, G., Demoule, A., Lavoué, S., Guervilly, C., Da Silva, D., Zafrani, L., Tirot, P., Veber, B., Maury, E., Levy, B., Cohen, Y., Richard, C., Kalfon, P., Bouadma, L., Mehdaoui, H., Beduneau, G., Lebreton, G., Brochard, L., Ferguson, N. D., Fan, E., Slutsky, A. S., Brodie, D., & Mercat, A.
Affiliations
  • Inserm (FR)
  • From Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition (A.C., G.L.), Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP) Hôpital Pitié–Salpêtrière (A.C.), Département de Biostatistiques, Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, APHP Hôpital Pitié–Salpêtrière (D.H.), Sorbonne Université, Unité de Recherche Clinique Pitié–Salpêtrière (D.H.), Sorbonne...
  • St. Michael's Hospital (CA)
  • University Health Network (CA)
  • NewYork–Presbyterian Hospital (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2018-05-24
Volume
378
Issue
21
Pages
1965-1975
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1800385
OpenAlex
W2803603947
Cited by
2,380
References
22
Citations by year
2026: 192 · 2025: 200 · 2024: 258 · 2023: 282 · 2022: 361 · 2021: 439 · 2020: 351 · 2019: 226 · 2018: 61 · 2017: 5 · 2013: 1
FWCI
203.06
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Funders
French Ministry of Health (PHRC 2009 081224)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
Keywords
extracorporeal membrane oxygenation, veno-venous ECMO, acute respiratory distress syndrome, refractory hypoxemia, 60-day mortality, conventional mechanical ventilation, bleeding complications, thrombocytopenia, ischemic stroke, ECMO complications
MeSH terms
Adult, Aged, Hypoxia, Female, Hemorrhage, Humans, Male, Middle Aged, Respiration, Artificial, Respiratory Distress Syndrome, Severity of Illness Index, Thrombocytopenia, Extracorporeal Membrane Oxygenation, Treatment Outcome, Cross-Over Studies, Kaplan-Meier Estimate

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