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Am J Respir Crit Care Med. 2012 Nov 15. [Epub ahead of print]
Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1) Induced Acute Respiratory Distress Syndrome. A Cohort Study and Propensity-matched Analysis.
Pham T, Combes A, Roz? H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Richard JC, Brun-Buisson C, Brochard L; For the REVA Research Network.
Source
R?animation M?dicale, Groupe Hospitalier Henri Mondor, Cr?teil, France.
Abstract
RATIONALE:
Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection received Extracorporeal Membrane Oxygenation (ECMO) as a rescue therapy.
OBJECTIVES:
To analyze factors associated with death in ECMO-treated patients and the influence of ECMO on ICU mortality.
METHODS:
Data from patients admitted for (H1N1)-associated ARDS to French Intensive Care Units (ICU) were prospectively collected from 2009 to 2011 through the national REVA registry. We analyzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using a propensity-score (PS) matched (1:1) cohort analysis.
MEASUREMENTS AND MAIN RESULTS:
123 patients received ECMO. By multivariate analysis, increasing values of age, lactate and plateau pressure under ECMO were associated with death. Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one matching and using controls only once. Mortality did not differ between the two matched cohorts (OR=1.48; 95%CI [0.68-3.23], p=0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower PaO2/FiO2 ratio, higher plateau pressure, but also a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%, p=0.005).
CONCLUSION:
Under ECMO, an ultra protective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe A(H1N1)-related ARDS treated with ECMO were compared to conventionally-treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic and younger ECMO-treated patients had, however, a lower mortality.
PMID:
23155145
[PubMed - as supplied by publisher]
Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1) Induced Acute Respiratory Distress Syndrome. A Cohort Study and Propensity-matched Analysis.
Pham T, Combes A, Roz? H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Richard JC, Brun-Buisson C, Brochard L; For the REVA Research Network.
Source
R?animation M?dicale, Groupe Hospitalier Henri Mondor, Cr?teil, France.
Abstract
RATIONALE:
Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection received Extracorporeal Membrane Oxygenation (ECMO) as a rescue therapy.
OBJECTIVES:
To analyze factors associated with death in ECMO-treated patients and the influence of ECMO on ICU mortality.
METHODS:
Data from patients admitted for (H1N1)-associated ARDS to French Intensive Care Units (ICU) were prospectively collected from 2009 to 2011 through the national REVA registry. We analyzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using a propensity-score (PS) matched (1:1) cohort analysis.
MEASUREMENTS AND MAIN RESULTS:
123 patients received ECMO. By multivariate analysis, increasing values of age, lactate and plateau pressure under ECMO were associated with death. Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one matching and using controls only once. Mortality did not differ between the two matched cohorts (OR=1.48; 95%CI [0.68-3.23], p=0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower PaO2/FiO2 ratio, higher plateau pressure, but also a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%, p=0.005).
CONCLUSION:
Under ECMO, an ultra protective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe A(H1N1)-related ARDS treated with ECMO were compared to conventionally-treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic and younger ECMO-treated patients had, however, a lower mortality.
PMID:
23155145
[PubMed - as supplied by publisher]
