Format

Send to

Choose Destination
Am J Respir Crit Care Med. 2013 Feb 1;187(3):276-85. doi: 10.1164/rccm.201205-0815OC. Epub 2012 Nov 15.

Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis.

Collaborators (145)

Zogheib E, Dupont H, Mercat A, Pierrot M, Capellier G, Verdiere B, Bastien O, Lehot JJ, Tonnelier JM, Guelon D, du Cheyron D, Thille A, Pham T, Brun-Buisson C, Quenot P, Arasomoano C, Minet C, Timsit JF, Dessertaine G, Robriquet L, Jaillette E, Castanier M, Roch A, Papazian L, Eliet J, Gaudard P, Machado S, Kuteifan K, Kimmoun A, Levy B, Bizouarn P, Villiers D, Guitton C, Dellamonica J, Boulain T, Mourvillier B, Bailly Salin J, Wolff M, Charpentier J, Chiche JD, Ricome S, Megarbane B, Combes A, Schmidt M, Bréchot N, Chastre J, Rozé H, Ouattara A, Robert R, Carise E, Reignier J, Beduneau G, Richard JC, Le Tulzo Y, Zeni F, Jospe R, Kummerlen C, Gouello JP, Cerf C, Devaquet J, Riu-Poulenc B, Luzi A, Georges B, Mayeur N, Mercier E, Guillon A, Eustache ML, Monon L, Cagnin S, Ronda J, Khechache A, Morteau B, Lecomte B, Merouani K, Siradot M, Tiger F, Benhamou M, Canevet C, Santoli F, Debbat K, Guerin AM, Favier L, Hilbert G, Castaing Y, Youssef J, Charron C, Ragot P, Freche A, Colin B, Ricard JD, Boulle Geronimi C, Abadie Y, Desbordes J, Antona M, Cheval C, Farhat R, Bousta M, Guilbaud JC, Fourrier F, Gastinne H, Clavel M, Vignon P, Gill A, Quiniot P, Guerin C, Rosselli S, Piriou V, Argaud L, Grelon F, Quesnay F, Courtin P, Vimieux S, Pascal M, Karcenty A, Daumal M, Bollaert PE, Bengler C, Voultoury J, Boulain T, Rezgui N, Rabat A, Duguet A, Faizy C, Guidet B, Lemiale V, Azoulay E, Fartoukh M, Badia P, Monseau Y, Richecoeur J, Chau TH, Beuret P, Delahaye A, Guivarch G, Lachérade JC, Theodore J, Tonduangu D, Lutun P, Dulac T, Boubien C, Arnal JM, Cantagrel S, Granclerc B, Floriot C, Henry-Lagarrigue M.

Author information

1
Service de Réanimation Médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France. taiopham@gmail.com

Abstract

RATIONALE:

Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection receive 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 intensive care unit (ICU) mortality.

METHODS:

Data from patients admitted for H1N1-associated ARDS to French ICUs 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-matched (1:1) cohort analysis.

MEASUREMENTS AND MAIN RESULTS:

A total of 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 control subjects only once. Mortality did not differ between the two matched cohorts (odds ratio, 1.48; 95% confidence interval, 0.68-3.23; P = 0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower Pa(o(2))/Fi(o(2)) ratio, had higher plateau pressure, but also had a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%; P < 0.01).

CONCLUSIONS:

Under ECMO, an ultraprotective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe influenza A(H1N1)-related ARDS treated with ECMO were compared with 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
DOI:
10.1164/rccm.201205-0815OC
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center