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- Title
Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation.
- Authors
Burrell, Aidan; Bailey, Michael J.; Bellomo, Rinaldo; Buscher, Hergen; Eastwood, Glenn; Forrest, Paul; Fraser, John F.; Fulcher, Bentley; Gattas, David; Higgins, Alisa M.; Hodgson, Carol L.; Litton, Edward; Martin, Emma-Leah; Nair, Priya; Ng, Sze J.; Orford, Neil; Ottosen, Kelly; Paul, Eldho; Pellegrino, Vincent; Reid, Liadain
- Abstract
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.
- Subjects
EXTRACORPOREAL membrane oxygenation; LENGTH of stay in hospitals; OXYGEN saturation; CARDIOGENIC shock; INTENSIVE care units
- Publication
Intensive Care Medicine, 2024, Vol 50, Issue 9, p1470
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-024-07564-8