Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/35485
Title: Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation.
Austin Authors: Burrell, Aidan;Bailey, Michael J;Bellomo, Rinaldo ;Buscher, Hergen;Eastwood, Glenn M ;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;Shekar, Kiran;Totaro, Richard J;Trapani, Tony;Udy, Andrew;Ziegenfuss, Marc;Pilcher, David
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.
Data Analytics Research and Evaluation (DARE) Centre
Intensive Care
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.
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.
Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.;Sydney Medical School, University of Sydney, Sydney, 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.
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
The George Institute for Global Health, Newtown, NSW, Australia.;Intensive Care Unit, St Vincent's Hospital, Darlinghurst, NSW, Australia.;University of New South Wales, Sydney, NSW, Australia.
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
Institute of Molecular Bioscience, The University of Queensland, Herston, QLD, Australia.;Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, QLD, Australia.
Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.;Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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.
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.
Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.;Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, QLD, Australia.
Issue Date: Sep-2024
Date: 2024
Publication information: Intensive Care Medicine 2024-09; 50(9)
Abstract: 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. 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. 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). 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/35485
DOI: 10.1007/s00134-024-07564-8
ORCID: 0000-0002-8939-7985
Journal: Intensive Care Medicine
Start page: 1470
End page: 1483
PubMed URL: 39162827
ISSN: 1432-1238
Type: Journal Article
Subjects: ECMO
Extracorporeal membrane oxygenation
Hyperoxaemia
Hyperoxia
Oxygen target
Extracorporeal Membrane Oxygenation/methods
Extracorporeal Membrane Oxygenation/adverse effects
Intensive Care Units/statistics & numerical data
Oxygen Saturation/physiology
Registries/statistics & numerical data
Shock, Cardiogenic/therapy
Shock, Cardiogenic/mortality
Heart Arrest/therapy
Heart Arrest/mortality
Appears in Collections:Journal articles

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