Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation.
ECMO
Extracorporeal membrane oxygenation
Hyperoxaemia
Hyperoxia
Oxygen target
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
20 Aug 2024
20 Aug 2024
Historique:
received:
12
03
2024
accepted:
17
07
2024
medline:
20
8
2024
pubmed:
20
8
2024
entrez:
20
8
2024
Statut:
aheadofprint
Résumé
Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia. In this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO From September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0-13.7] versus liberal: 0 days [IQR 0-13.7], median treatment effect: 0 days [95% confidence interval (CI) - 3.1 to 3.1]). Mortality at day 28 (59/159 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001). In adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28.
Identifiants
pubmed: 39162827
doi: 10.1007/s00134-024-07564-8
pii: 10.1007/s00134-024-07564-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : MRFF, Australia
ID : APP1152270
Investigateurs
Carol L Hodgson
(CL)
Richard J Totaro
(RJ)
Michael Bailey
(M)
Amanda Corley
(A)
John Fraser
(J)
Alisa Higgins
(A)
Andrew Hilton
(A)
Carol Hodgson
(C)
Sze Ng
(S)
Richard Totaro
(R)
Meredith Young
(M)
Jasmin Board
(J)
Annalie Jones
(A)
Phoebe McCracken
(P)
Alastair Brown
(A)
Helen Young
(H)
Leah Peck
(L)
Andrew Hilton
(A)
John Dyett
(J)
Stephanie Hunter
(S)
Cheelim Liew
(C)
Kym Gellie
(K)
Nicole Robertson
(N)
Anne-Marie Palermo
(AM)
Chris Allen
(C)
Ubbo Wiersema
(U)
Joanne McIntyre
(J)
Shailesh Bihari
(S)
Joe McCaffrey
(J)
Matthew Maiden
(M)
Nima Kakho
(N)
Allison Bone
(A)
Tania Salerno
(T)
Michelle Horton
(M)
Jemma Trickey
(J)
Samantha Breguet
(S)
Lucy Range
(L)
Meg Gallagher
(M)
James Winearls
(J)
Mandy Tallott
(M)
Maimoonbe Gough
(M)
Julie Pitman
(J)
James McCullough
(J)
Maree Houbert
(M)
Lewis McLean
(L)
Amber-Louise Poulter
(AL)
Sarah Dalton
(S)
Jorge Brieva
(J)
Lucas Webb
(L)
Daniel de Wit
(D)
James Walsham
(J)
Jason Meyer
(J)
Meg Harward
(M)
Anand Krishnan
(A)
Cassie Jones
(C)
Josephine Mackay
(J)
Benjamin Reddi
(B)
Stephanie O'Connor
(S)
Kathleen Glasby
(K)
Nerissa Brown
(N)
Sarah Doherty
(S)
Justine Rivett
(J)
Fiona McDonald
(F)
Sophie Dohnt
(S)
Mahni Foster
(M)
Richard Totaro
(R)
Heidi Buhr
(H)
Jennifer Coles
(J)
Ruaidhri Carey
(R)
Sally Newman
(S)
Claire Reynolds
(C)
John Fraser
(J)
Andrew Thomas
(A)
Rachel Bushell
(R)
Dawn Lockwood
(D)
Oystein Tronstad
(O)
Jiville Latu
(J)
India Pearse
(I)
Niall D Ferguson
(ND)
Lehana Thabane
(L)
Matthieu Schmidt
(M)
Informations de copyright
© 2024. The Author(s).
Références
Lorusso R, Shekar K, MacLaren G, Schmidt M, Pellegrino V, Meyns B, Haft J, Vercaemst L, Pappalardo F, Bermudez C, Belohlavek J, Hou X, Boeken U, Castillo R, Donker DW, Abrams D, Ranucci M, Hryniewicz K, Chavez I, Chen YS, Salazar L, Whitman G (2021) ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J 67:827–844
doi: 10.1097/MAT.0000000000001510
pubmed: 34339398
Munshi L, Kiss A, Cypel M, Keshavjee S, Ferguson ND, Fan E (2017) Oxygen thresholds and mortality during extracorporeal life support in adult patients. Crit Care Med 45:1997–2005
doi: 10.1097/CCM.0000000000002643
pubmed: 28787294
Premraj L, Brown A, Fraser JF, Pellegrino V, Pilcher D, Burrell A (2023) Oxygenation during venoarterial extracorporeal membrane oxygenation: physiology, current evidence, and a pragmatic approach to oxygen titration. Crit Care Med 52(4):637–648
doi: 10.1097/CCM.0000000000006134
pubmed: 38059745
McDonald CI, Fraser JF, Coombes JS, Fung YL (2014) Oxidative stress during extracorporeal circulation. Eur J Cardiothorac Surg 46:937–943
doi: 10.1093/ejcts/ezt637
pubmed: 24482384
Fujii Y, Tatsumi E, Nakamura F, Oite T (2020) PaO
doi: 10.21037/jtd.2019.12.113
pubmed: 32274141
pmcid: 7139026
Jentzer JC, Miller PE, Tonna JE (2023) Response by Jentzer et al to letters regarding article, “Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock.” Circ Heart Fail 16:e010732
pubmed: 37387228
pmcid: 10361256
Tigano S, Caruso A, Liotta C, LaVia L, Vargas M, Romagnoli S, Landoni G, Sanfilippo F (2024) Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis. Resuscitation 194:110071
doi: 10.1016/j.resuscitation.2023.110071
pubmed: 38061577
Barrot L, Asfar P, Mauny F, Winiszewski H, Montini F, Badie J, Quenot JP, Pili-Floury S, Bouhemad B, Louis G, Souweine B, Collange O, Pottecher J, Levy B, Puyraveau M, Vettoretti L, Constantin JM, Capellier G, Network LIaRR (2020) Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome. N Engl J Med 382:999–1008
doi: 10.1056/NEJMoa1916431
pubmed: 32160661
Klitgaard TL, Schjørring OL, Nielsen FM, Meyhoff CS, Perner A, Wetterslev J, Rasmussen BS, Barbateskovic M (2023) Higher versus lower fractions of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database Syst Rev 9:CD012631
pubmed: 37700687
Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P, Investigators E (2022) Effect of lower vs higher oxygen saturation targets on survival to hospital discharge among patients resuscitated after out-of-hospital cardiac arrest: the EXACT randomized clinical trial. JAMA 328:1818–1826
doi: 10.1001/jama.2022.17701
pubmed: 36286192
pmcid: 9608019
Richardson ASC, Tonna JE, Nanjayya V, Nixon P, Abrams DC, Raman L, Bernard S, Finney SJ, Grunau B, Youngquist ST, McKellar SH, Shinar Z, Bartos JA, Becker LB, Yannopoulos D, Bˇelohlávek J, Lamhaut L, Pellegrino V (2021) Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the extracorporeal life support organization. ASAIO J 67:221–228
doi: 10.1097/MAT.0000000000001344
pubmed: 33627592
Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D (2023) Blend to limit OxygEN in ECMO: a RanDomised ControllEd Registry (BLENDER) trial: study protocol and statistical analysis plan. Crit Care Resusc 25:118–125
pubmed: 37876374
pmcid: 10581278
Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D (2024) Corrigendum to “Blend to Limit OxygEN in ECMO: a RanDomised ControllEd Registry (BLENDER) trial: study protocol and statistical analysis plan.” Crit Care Resusc 26(1):60
pubmed: 38690184
pmcid: 11056403
Forster GM, Bihari S, Tiruvoipati R, Bailey M, Pilcher D (2020) The association between discharge delay from intensive care and patient outcomes. Am J Respir Crit Care Med 202:1399–1406
doi: 10.1164/rccm.201912-2418OC
pubmed: 32649212
Hodgson CL, Fulcher B, Mariajoseph FP, Burrell AJC, Pellegrino V, Brodie D, Fan E, Network SSIobotIE (2021) A core outcome set for research in patients on extracorporeal membrane oxygenation. Crit Care Med 49:e1252–e1254
doi: 10.1097/CCM.0000000000005110
pubmed: 34074857
Hodgson CL, Higgins AM, Bailey MJ, Anderson S, Bernard S, Fulcher BJ, Koe D, Linke NJ, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Sheldrake J, Reddi BAJ, Stub D, Trapani TV, Udy AA, SerpaNeto A, Group ESIobotIENatAaNZICSCT (2022) Incidence of death or disability at 6 months after extracorporeal membrane oxygenation in Australia: a prospective, multicentre, registry-embedded cohort study. Lancet Respir Med 10:1038–1048
doi: 10.1016/S2213-2600(22)00248-X
pubmed: 36174613
Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation (2022) Adult Patient Database Data Dictionary Version 6.1. https://anzics.org/wp-content/uploads/2021/03/ANZICS-APD-Dictionary-Version-6.1.pdf . Accessed 11 June 2024
Secombe P, Millar J, Litton E, Chavan S, Hensman T, Hart GK, Slater A, Herkes R, Huckson S, Pilcher DV (2023) Thirty years of ANZICS CORE: a clinical quality success story. Crit Care Resusc 25:43–46
pubmed: 37876992
pmcid: 10581273
Burrell AJ, Pellegrino VA, Wolfe R, Wong WK, Cooper DJ, Kaye DM, Pilcher DV (2015) Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation. J Crit Care 30(5):949–956
doi: 10.1016/j.jcrc.2015.05.022
pubmed: 26111916
Lau B, Cole SR, Gange SJ (2009) Competing risk regression models for epidemiologic data. Am J Epidemiol 170:244–256
doi: 10.1093/aje/kwp107
pubmed: 19494242
pmcid: 2732996
Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D (2015) Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 36:2246–2256
doi: 10.1093/eurheartj/ehv194
pubmed: 26033984
Halter M, Jouffroy R, Saade A, Philippe P, Carli P, Vivien B (2020) Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest. Am J Emerg Med 38:900–905
doi: 10.1016/j.ajem.2019.07.008
pubmed: 31303537
Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, Parrillo JE, Trzeciak S, Investigators EMSRNE (2010) Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 303:2165–2171
doi: 10.1001/jama.2010.707
pubmed: 20516417
Boyle AJ, Holmes DN, Hackett J, Gilliland S, McCloskey M, O’Kane CM, Young P, Di Gangi S, McAuley DF (2021) Hyperoxaemia and hypoxaemia are associated with harm in patients with ARDS. BMC Pulm Med 21:285
doi: 10.1186/s12890-021-01648-7
pubmed: 34496830
pmcid: 8424163
Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, Szczeklik W, Schünemann HJ, Neary JD, Alhazzani W (2018) Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 391:1693–1705
doi: 10.1016/S0140-6736(18)30479-3
pubmed: 29726345
Bonnemain J, Rusca M, Ltaief Z, Roumy A, Tozzi P, Oddo M, Kirsch M, Liaudet L (2021) Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality. BMC Cardiovasc Disord 21:542
doi: 10.1186/s12872-021-02361-3
pubmed: 34775951
pmcid: 8591834
Moussa MD, Beyls C, Lamer A, Roksic S, Juthier F, Leroy G, Petitgand V, Rousse N, Decoene C, Dupré C, Caus T, Huette P, Guilbart M, Guinot PG, Besserve P, Mahjoub Y, Dupont H, Robin E, Meynier J, Vincentelli A, Abou-Arab O (2022) Early hyperoxia and 28-day mortality in patients on venoarterial ECMO support for refractory cardiogenic shock: a bicenter retrospective propensity score-weighted analysis. Crit Care 26:257
doi: 10.1186/s13054-022-04133-7
pubmed: 36028883
pmcid: 9414410
Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, Morelli A, Antonelli M, Singer M (2016) Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 316:1583–1589
doi: 10.1001/jama.2016.11993
pubmed: 27706466
Asfar P, Schortgen F, Boisramé-Helms J, Charpentier J, Guérot E, Megarbane B, Grimaldi D, Grelon F, Anguel N, Lasocki S, Henry-Lagarrigue M, Gonzalez F, Legay F, Guitton C, Schenck M, Doise JM, Devaquet J, Van Der Linden T, Chatellier D, Rigaud JP, Dellamonica J, Tamion F, Meziani F, Mercat A, Dreyfuss D, Seegers V, Radermacher P, Investigators HS, network Rr (2017) Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. Lancet Respir Med 5:180–190
doi: 10.1016/S2213-2600(17)30046-2
pubmed: 28219612
Mackle D, Bellomo R, Bailey M, Beasley R, Deane A, Eastwood G, Finfer S, Freebairn R, King V, Linke N, Litton E, McArthur C, McGuinness S, Panwar R, Young P, Group I-RIatAaNZICSCT, Group I-RItAaNZICSCT (2020) Conservative oxygen therapy during mechanical ventilation in the ICU. N Engl J Med 382:989–998
doi: 10.1056/NEJMoa1903297
pubmed: 31613432
Schmidt H, Kjaergaard J, Hassager C, Mølstrøm S, Grand J, Borregaard B, RoelsgaardObling LE, Venø S, Sarkisian L, Mamaev D, Jensen LO, Nyholm B, Høfsten DE, Josiassen J, Thomsen JH, Thune JJ, Lindholm MG, Stengaard Meyer MA, Winther-Jensen M, Sørensen M, Frydland M, Beske RP, Frikke-Schmidt R, Wiberg S, Boesgaard S, Lind Jørgensen V, Møller JE (2022) Oxygen targets in comatose survivors of cardiac arrest. N Engl J Med 387:1467–1476
doi: 10.1056/NEJMoa2208686
pubmed: 36027567
Semler MW, Casey JD, Lloyd BD, Hastings PG, Hays MA, Stollings JL, Buell KG, Brems JH, Qian ET, Seitz KP, Wang L, Lindsell CJ, Freundlich RE, Wanderer JP, Han JH, Bernard GR, Self WH, Rice TW, Group PIatPCCR (2022) Oxygen-saturation targets for critically ill adults receiving mechanical ventilation. N Engl J Med 387:1759–1769
doi: 10.1056/NEJMoa2208415
pubmed: 36278971
pmcid: 9724830
Schjørring OL, Klitgaard TL, Perner A, Wetterslev J, Lange T, Siegemund M, Bäcklund M, Keus F, Laake JH, Morgan M, Thormar KM, Rosborg SA, Bisgaard J, Erntgaard AES, Lynnerup AH, Pedersen RL, Crescioli E, Gielstrup TC, Behzadi MT, Poulsen LM, Estrup S, Laigaard JP, Andersen C, Mortensen CB, Brand BA, White J, Jarnvig IL, Møller MH, Quist L, Bestle MH, Schønemann-Lund M, Kamper MK, Hindborg M, Hollinger A, Gebhard CE, Zellweger N, Meyhoff CS, Hjort M, Bech LK, Grøfte T, Bundgaard H, Østergaard LHM, Thyø MA, Hildebrandt T, Uslu B, Sølling CG, Møller-Nielsen N, Brøchner AC, Borup M, Okkonen M, Dieperink W, Pedersen UG, Andreasen AS, Buus L, Aslam TN, Winding RR, Schefold JC, Thorup SB, Iversen SA, Engstrøm J, Kjær MN, Rasmussen BS, Investigators H-I (2021) Lower or higher oxygenation targets for acute hypoxemic respiratory failure. N Engl J Med 384:1301–1311
doi: 10.1056/NEJMoa2032510
pubmed: 33471452
Dumas G, Morris IS, Hensman T, Bagshaw SM, Demoule A, Ferreyro BL, Kouatchet A, Lemiale V, Mokart D, Pene F, Mehta S, Azoulay E, Munshi L, the AnzicstCC, the G-OHSG (2024) Association between arterial oxygen and mortality across critically ill patients with hematologic malignancies: results from an international collaborative network. Intensive Care Med 50:697–711
doi: 10.1007/s00134-024-07389-5
pubmed: 38598124
Buell KG, Spicer AB, Casey JD, Seitz KP, Qian ET, Graham Linck EJ, Self WH, Rice TW, Sinha P, Young PJ, Semler MW, Churpek MM (2024) Individualized treatment effects of oxygen targets in mechanically ventilated critically ill adults. JAMA 331:1195–1204
doi: 10.1001/jama.2024.2933
pubmed: 38501205