Skip to main content
SpringerLink
Log in

ECMO After EOLIA: The Evolving Role of Extracorporeal Support in ARDS

  • Chapter
  • First Online:
Book cover Annual Update in Intensive Care and Emergency Medicine 2019

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Over the past decade, the rapidly expanding use of extracorporeal membrane oxygenation (ECMO) for the acute respiratory distress syndrome (ARDS) has outpaced the evidence. Before 2018, there had only been one large, randomized clinical trial involving relatively modern extracorporeal technology that evaluated the impact of ECMO on acute respiratory failure, predominately ARDS. Advances in ECMO technology, coupled with improvements in the management of ARDS, made it apparent that in order to clarify the role of ECMO for patients with severe forms of ARDS, further high-quality evidence would be needed [1]. The ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial compared the impact of early venovenous ECMO (VV-ECMO) in patients with severe forms of ARDS against optimal conventional standard-of-care management [2]. Despite failing to meet the primary outcome of improved survival with ECMO at 60 days, the results of EOLIA are more nuanced than the trial conclusion might suggest. A comprehensive analysis of EOLIA provides valuable insights into the evolving role of ECMO and its future use in ARDS. This chapter will summarize the rationale for the trial, provide an in-depth interpretation of the results, and explore their implications on the role of ECMO in the management of ARDS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Combes A, Brodie D, Chen YS, et al. The ICM research agenda on extracorporeal life support. Intensive Care Med. 2017;43:1306–18.

    Article  Google Scholar 

  2. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–75.

    Article  Google Scholar 

  3. Ranieri VM, Brodie D, Vincent JL. Extracorporeal organ support: from technological tool to clinical strategy supporting severe organ failure. JAMA. 2017;318:1105–6.

    Article  Google Scholar 

  4. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365:1905–14.

    Article  CAS  Google Scholar 

  5. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA. 2018;319:698–710.

    Article  Google Scholar 

  6. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.

    PubMed  Google Scholar 

  7. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800.

    Article  CAS  Google Scholar 

  8. Herridge MS, Tansey CM, Matte A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–304.

    Article  CAS  Google Scholar 

  9. Hill JD, O’Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972;286:629–34.

    Article  CAS  Google Scholar 

  10. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;242:2193–6.

    Article  CAS  Google Scholar 

  11. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:295–305.

    Article  CAS  Google Scholar 

  12. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.

    Article  Google Scholar 

  13. Davies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.

    Article  CAS  Google Scholar 

  14. Freebairn R, McHugh G, Hickling K. Extracorporeal membrane oxygenation for ARDS due to 2009 influenza A(H1N1). JAMA. 2010;303:941–2; author Reply 2

    Article  CAS  Google Scholar 

  15. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306:1659–68.

    Article  CAS  Google Scholar 

  16. Pham T, Combes A, Roze H, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187:276–85.

    Article  CAS  Google Scholar 

  17. Zangrillo A, Biondi-Zoccai G, Landoni G, et al. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO. Crit Care. 2013;17:R30.

    Article  Google Scholar 

  18. Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. ASAIO J. 2015;61:31–6.

    Article  CAS  Google Scholar 

  19. Karagiannidis C, Brodie D, Strassmann S, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42:889–96.

    Article  CAS  Google Scholar 

  20. Tramm R, Ilic D, Davies AR, Pellegrino VA, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev. 2015;1:CD010381.

    PubMed  Google Scholar 

  21. Abrams D, Brodie D. Extracorporeal circulatory approaches to treat acute respiratory distress syndrome. Clin Chest Med. 2014;35:765–79.

    Article  Google Scholar 

  22. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  23. Mercat A, Richard JC, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:646–55.

    Article  CAS  Google Scholar 

  24. Rubenfeld GD, Cooper C, Carter G, Thompson BT, Hudson LD. Barriers to providing lung-protective ventilation to patients with acute lung injury. Crit Care Med. 2004;32:1289–93.

    Article  Google Scholar 

  25. Hager DN, Krishnan JA, Hayden DL, Brower RG. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med. 2005;172:1241–5.

    Article  Google Scholar 

  26. Terragni PP, Del Sorbo L, Mascia L, et al. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009;111:826–35.

    Article  Google Scholar 

  27. Needham DM, Colantuoni E, Mendez-Tellez PA, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124.

    Article  Google Scholar 

  28. Bein T, Weber-Carstens S, Goldmann A, et al. Lower tidal volume strategy (approximately 3 mL/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 mL/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med. 2013;39:847–56.

    Article  Google Scholar 

  29. Marhong JD, Munshi L, Detsky M, Telesnicki T, Fan E. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Med. 2015;41:994–1003.

    Article  Google Scholar 

  30. Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.

    Article  CAS  Google Scholar 

  31. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16.

    Article  CAS  Google Scholar 

  32. Young D, Lamb SE, Shah S, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806–13.

    Article  CAS  Google Scholar 

  33. Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795–805.

    Article  CAS  Google Scholar 

  34. Hodgson CL, Tuxen DV, Davies AR, et al. A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome. Crit Care. 2011;15:R133.

    Article  Google Scholar 

  35. Cavalcanti AB, Suzumura EA, Laranjeira LN, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs. low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318:1335–45.

    Article  Google Scholar 

  36. Artigas A, Camprubi-Rimblas M, Tantinya N, Bringue J, Guillamat-Prats R, Matthay MA. Inhalation therapies in acute respiratory distress syndrome. Ann Transl Med. 2017;5:293.

    Article  Google Scholar 

  37. Combes A, Brechot N, Luyt CE, Schmidt M. Indications for extracorporeal support: why do we need the results of the EOLIA trial? Med Klin Intensivmed Notfmed. 2018;113:21–5.

    Article  CAS  Google Scholar 

  38. Gattinoni L, Vasques F, Quintel M. Use of ECMO in ARDS: does the EOLIA trial really help? Crit Care. 2018;22:171.

    Article  Google Scholar 

  39. Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O’Brien CR, Rubenfeld GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med. 2006;355:41–50.

    Article  CAS  Google Scholar 

  40. Barbaro RP, Odetola FO, Kidwell KM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191:894–901.

    Article  Google Scholar 

  41. Combes A, Brodie D, Bartlett R, et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190:488–96.

    Article  Google Scholar 

  42. Salna M, Chicotka S, Biscotti M 3rd, et al. Management of surge in extracorporeal membrane oxygenation transport. Ann Thorac Surg. 2018;105:528–34.

    Article  Google Scholar 

  43. Higgins AM, Pettila V, Harris AH, et al. The critical care costs of the influenza A/H1N1 2009 pandemic in Australia and New Zealand. Anaesth Intensive Care. 2011;39:384–91.

    Article  CAS  Google Scholar 

  44. Park M, Mendes PV, Zampieri FG, et al. The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis. Rev Bras Ter Intensiva. 2014;26:253–62.

    PubMed  PubMed Central  Google Scholar 

  45. Harrington D, Drazen JM. Learning from a trial stopped by a data and safety monitoring board. N Engl J Med. 2018;378:2031–2.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA

    M. Salna

  2. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA

    D. Abrams & D. Brodie

Authors
  1. M. Salna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Abrams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Brodie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Brodie .

Editor information

Editors and Affiliations

  1. Dept. of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Salna, M., Abrams, D., Brodie, D. (2019). ECMO After EOLIA: The Evolving Role of Extracorporeal Support in ARDS. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2019. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-06067-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-06067-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06066-4

  • Online ISBN: 978-3-030-06067-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation