Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study
Authors' conclusion
A standardized approach was safe and feasible allowing extubation during ECMO in 21% of patients with severe ARDS, selecting patients who will have a shorter duration of invasive mechanical ventilation, ECMO course, and ICU stay, as well as fewer infectious complications, and high hospital survival.
Study context
- Population
- Adults with severe acute respiratory distress syndrome (ARDS) on ECMO, 4 intensive care units (ICUs) at 2 tertiary ECMO centers over 6 years6 years
- Participants
- 254 adults · 4 ICUs
- Exposure
- Extubated during ECMO vs not extubated during ECMO
- Extubated during ECMOn = 54
- Outcome
- Safety and feasibility of a standardized approach for extubation during ECMO
Methodological detailsstandardized extubation approach, 4 ICUs, 2 tertiary ECMO centers
- Standardized extubation approach
- 4 ICUs, 2 tertiary ECMO centers
Main finding
As reported in the abstract
Extubated during ECMO
Fifty-four (21%)
Did not reach clinical criteria
167
66%
Gas exchange precluded extubation
33
13%
Observational data: associations, not effects.
Further findings
SOFA score at ECMO initiation (extubated during ECMO vs not)
- Lower SOFA score in patients extubated during ECMO vs not extubated, with similar PaO2/FiO2
- OR 0.88 (95% CI 0.79-0.98, P = .02)
Duration of invasive mechanical ventilation
- Extubation during ECMO associated with shorter duration of invasive mechanical ventilation (extubated vs not, days; P < .01)
- 7 (4-18) vs. 32 (18-54) days
Duration of ECMO
- Extubation during ECMO associated with shorter duration of ECMO (extubated vs not, days; P = .01)
- 12 (7-25) vs. 19 (10-41) days
All-cause death
- Extubation during ECMO associated with lower risk of all-cause death, independently of measured confounding
- adjusted logistic regression OR 0.23 (95% CI 0.08-0.69, P = .008)
Safety
Hemorrhagic shock
- Lower incidence of hemorrhagic shock with extubation during ECMO (extubated vs not; P = .05)
- 2 vs. 11%
Cannula-associated DVT
- More cannula-associated DVT with extubation during ECMO (extubated vs not; P = .02)
- 49 vs. 31%
Failed extubation
- More failed extubation with extubation during ECMO (extubated vs not; P < .01)
- 20 vs. 6%
Major adverse events
- No increased major adverse events
Original publication
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