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Indications for extracorporeal support: why do we need the results of the EOLIA trial?
Med Klin Intensivmed Notfmed. 2018 02; 113(Suppl 1):21-25.MK

Abstract

Acute respiratory distress syndrome (ARDS) is a severe lung disease, with an associated mortality rate exceeding 60% for the most severe forms of the disease. In these situations, establishing an extracorporeal circuit, combining a centrifugal pump and a membrane oxygenator (extra-corporeal membrane oxygenation, ECMO), can ensure total pulmonary assistance and allow the lungs to rest under ultraprotective mechanical ventilation. Unfortunately, former trials of ECMO in ARDS were negative or highly criticized due to many technical and methodological shortcomings. Prior to the widespread use of venovenous ECMO for severe ARDS, new trials are needed to test the efficacy of early initiation of the technique with tight control of mechanical ventilation in the control group, initiation of ECMO prior to transportation to ECMO centers, and the use of ECMO in all patients randomly assigned to receive this treatment. Therefore, the international multicenter randomized EOLIA (ECMO to rescue Lung Injury in severe ARDS) trial was designed to test the benefit of systematic and early installation of the latest-generation ECMO circuits in patients with very severe ARDS. Patients randomized to the control group were managed with tight control of mechanical ventilation and recourse to paralyzing agents and prone positioning, while an ethical crossover option to ECMO was permitted only if refractory hypoxemia (SaO2 < 80%) lasted for > 6 h despite all possible conventional emergency interventions. The primary endpoint of the study was the 60-day mortality rate, with an expected 20% absolute mortality reduction with ECMO.

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Authors+Show Affiliations

Combes A
Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France. alain.combes@aphp.fr. Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France. alain.combes@aphp.fr. Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Groupe Hospitalier Pitié-Salpêtrière 47, boulevard de l'Hôpital, 75651, Paris Cedex 13, France. alain.combes@aphp.fr.
Bréchot N
Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France. Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.
Luyt CE
Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France. Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.
Schmidt M
Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France. Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.

MeSH

Extracorporeal Membrane OxygenationHumansOxygenators, MembraneProspective StudiesRandomized Controlled Trials as TopicRespiration, ArtificialRespiratory Distress Syndrome

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29149363

Citation

Combes, A, et al. "Indications for Extracorporeal Support: Why Do We Need the Results of the EOLIA Trial?" Medizinische Klinik, Intensivmedizin Und Notfallmedizin, vol. 113, no. Suppl 1, 2018, pp. 21-25.
Combes A, Bréchot N, Luyt CE, et al. Indications for extracorporeal support: why do we need the results of the EOLIA trial? Med Klin Intensivmed Notfmed. 2018;113(Suppl 1):21-25.
Combes, A., Bréchot, N., Luyt, C. E., & Schmidt, M. (2018). Indications for extracorporeal support: why do we need the results of the EOLIA trial? Medizinische Klinik, Intensivmedizin Und Notfallmedizin, 113(Suppl 1), 21-25. https://doi.org/10.1007/s00063-017-0371-0
Combes A, et al. Indications for Extracorporeal Support: Why Do We Need the Results of the EOLIA Trial. Med Klin Intensivmed Notfmed. 2018;113(Suppl 1):21-25. PubMed PMID: 29149363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indications for extracorporeal support: why do we need the results of the EOLIA trial? AU - Combes,A, AU - Bréchot,N, AU - Luyt,C-E, AU - Schmidt,M, Y1 - 2017/11/17/ PY - 2017/05/22/received PY - 2017/10/05/accepted PY - 2017/11/18/pubmed PY - 2019/5/30/medline PY - 2017/11/18/entrez KW - Absolute mortality KW - Acute respiratory distress syndrome KW - Extracorporeal membrane oxygenation KW - Mechanical ventilation KW - Randomized trial SP - 21 EP - 25 JF - Medizinische Klinik, Intensivmedizin und Notfallmedizin JO - Med Klin Intensivmed Notfmed VL - 113 IS - Suppl 1 N2 - Acute respiratory distress syndrome (ARDS) is a severe lung disease, with an associated mortality rate exceeding 60% for the most severe forms of the disease. In these situations, establishing an extracorporeal circuit, combining a centrifugal pump and a membrane oxygenator (extra-corporeal membrane oxygenation, ECMO), can ensure total pulmonary assistance and allow the lungs to rest under ultraprotective mechanical ventilation. Unfortunately, former trials of ECMO in ARDS were negative or highly criticized due to many technical and methodological shortcomings. Prior to the widespread use of venovenous ECMO for severe ARDS, new trials are needed to test the efficacy of early initiation of the technique with tight control of mechanical ventilation in the control group, initiation of ECMO prior to transportation to ECMO centers, and the use of ECMO in all patients randomly assigned to receive this treatment. Therefore, the international multicenter randomized EOLIA (ECMO to rescue Lung Injury in severe ARDS) trial was designed to test the benefit of systematic and early installation of the latest-generation ECMO circuits in patients with very severe ARDS. Patients randomized to the control group were managed with tight control of mechanical ventilation and recourse to paralyzing agents and prone positioning, while an ethical crossover option to ECMO was permitted only if refractory hypoxemia (SaO2 < 80%) lasted for > 6 h despite all possible conventional emergency interventions. The primary endpoint of the study was the 60-day mortality rate, with an expected 20% absolute mortality reduction with ECMO. SN - 2193-6226 UR - https://www.unboundmedicine.com/medline/citation/29149363/Indications_for_extracorporeal_support:_why_do_we_need_the_results_of_the_EOLIA_trial DB - PRIME DP - Unbound Medicine ER -