| Title: |
Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation |
| Authors: |
Burrell, A; Bailey, MJ; Bellomo, R; Buscher, H; Eastwood, G; Forrest, P; Fraser, JF; Fulcher, B; Gattas, D; Higgins, AM; Hodgson, CL; Litton, E; Martin, EL; Nair, P; Ng, SJ; Orford, N; Ottosen, K; Paul, E; Pellegrino, V; Reid, L; Shekar, K; Totaro, RJ; Trapani, T; Udy, A; Ziegenfuss, M; Pilcher, D; Schmidt, M; Thabane, L; Ferguson, ND; Pearse, I; Latu, J; Tronstad, O; Lockwood, D; Bushell, R; Thomas, A; Fraser, J; Reynolds, C; Newman, S; Carey, R; Coles, J; Buhr, H; Foster, M; Dohnt, S; McDonald, F; Rivett, J; Doherty, S; Brown, N; Glasby, K; O’Connor, S; Reddi, B; Mackay, J; Jones, C; Krishnan, A; Harward, M; Meyer, J; Walsham, J; de Wit, D; Webb, L; Brieva, J; Dalton, S; Poulter, AL; McLean, L; Houbert, M; McCullough, J; Pitman, J; Gough, M; Tallott, M; Winearls, J; Gallagher, M; Range, L; Breguet, S; Trickey, J; Horton, M; Salerno, T; Bone, A; Kakho, N; Maiden, M; McCaffrey, J; Bihari, S; McIntyre, J; Wiersema, U; Allen, C; Palermo, AM; Robertson, N; Gellie, K; Liew, C; Hunter, S; Dyett, J; Hilton, A; Peck, L; Young, H; Brown, A; McCracken, P; Jones, A; Board, J; Young, M; Ng, S; Corley, A |
| Publisher Information: |
Springer Science and Business Media LLC |
| Publication Year: |
2024 |
| Collection: |
The University of Melbourne: Digital Repository |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
0342-4642 |
| Relation: |
https://hdl.handle.net/11343/358572 |
| Availability: |
https://hdl.handle.net/11343/358572 |
| Rights: |
https://creativecommons.org/licenses/by-nc/4.0 ; CC BY-NC |
| Accession Number: |
edsbas.FEC4673 |
| Database: |
BASE |