Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation,Intensive Care Medicine

当前位置： X-MOL 学术 › Intensive Care Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-08-20 , DOI: 10.1007/s00134-024-07564-8
Aidan Burrell _{1,

2} , Michael J Bailey ₁ , Rinaldo Bellomo _{1,

3,

4} , Hergen Buscher _{1,

5} , Glenn Eastwood _{1,

6} , Paul Forrest _{7,

8} , John F Fraser _{9,

10} , Bentley Fulcher ₁ , David Gattas _{7,

8} , Alisa M Higgins _{1,

11} , Carol L Hodgson _{1,

2,

3} , Edward Litton _{12,

13} , Emma-Leah Martin ₂ , Priya Nair _{11,

14,

15} , Sze J Ng ₁ , Neil Orford _{1,

16,

17} , Kelly Ottosen ₁ , Eldho Paul ₁ , Vincent Pellegrino ₂ , Liadain Reid ₁ , Kiran Shekar _{9,

18} , Richard J Totaro _{7,

8} , Tony Trapani ₁ , Andrew Udy _{1,

2} , Marc Ziegenfuss _{10,

18} , David Pilcher _{1,

2,

13} ,

Affiliation

Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia.
Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, VIC, Australia.
St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.
Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Institute of Molecular Bioscience, The University of Queensland, Herston, QLD, Australia.
Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.
The George Institute for Global Health, Newtown, NSW, Australia.
Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia.
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, Melbourne, VIC, Australia.
Intensive Care Unit, St Vincent's Hospital, Darlinghurst, NSW, Australia.
University of New South Wales, Sydney, NSW, Australia.
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, Australia.
Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, QLD, Australia.

Purpose

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.

Methods

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 SaO₂ 92–96%) or to a liberal oxygen strategy (target SaO₂ 97–100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months.

Results

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).

Conclusions

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.

中文翻译：

静脉动脉体外膜肺氧合患者的保守或自由氧疗目标

目的

接受静脉动脉体外膜肺氧合（VA-ECMO）的患者经常发生动脉高氧血症，这可能是有害的。然而，较低的氧饱和度目标也可能导致有害的低氧血症发作。

方法

在这项注册嵌入的多中心试验中，我们将重症监护病房（ICU）中接受 VA-ECMO 的成年患者随机分配到保守（目标 SaO₂ 92-96%）或自由氧疗策略（目标 SaO₂ 97-100%），通过呼吸机和 ECMO 气体混合器进行受控氧气给药。主要结局是至第 28 天的无 ICU 天数。次要结局包括第 60 天无 ICU 天数、死亡率、ECMO 和通气持续时间、ICU 和住院时间以及 6 个月时的功能结局。

结果

从 2019 年 9 月到 2023 年 6 月，向 EXCEL 登记处报告了 934 名接受 VA-ECMO 的患者，其中 300 名（192 名心源性休克，108 名难治性心脏骤停）。我们将 149 例随机分配到保守组，将 151 例随机分配到自由氧疗组。两组至第 28 天的无 ICU 天数的中位数相似（保守：0 天 [四分位距（IQR） 0-13.7] 与自由：0 天 [IQR 0-13.7]，中位治疗效果：0 天 [95% 置信区间（CI） – 3.1 至 3.1]）。保守组和自由组第 28 天（59/159 [39.6%] vs 59/151 [39.1%]）和第 60 天（64/149 [43%] vs 62/151 [41.1%] 的死亡率相似，所有其他次要结局和不良事件也相似。保守组经历了 44 例（29.5%）主要方案偏差，而自由氧组经历了 2 例（1.3%）（P < 0.001）。