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Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1) Induced Acute Respiratory Distress Syndrome. A Cohort Study and Propensity-matched Analysis.
MedLine Citation:
PMID:  23155145     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection received Extracorporeal Membrane Oxygenation (ECMO) as a rescue therapy. OBJECTIVES: To analyze factors associated with death in ECMO-treated patients and the influence of ECMO on ICU mortality. METHODS: Data from patients admitted for (H1N1)-associated ARDS to French Intensive Care Units (ICU) were prospectively collected from 2009 to 2011 through the national REVA registry. We analyzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using a propensity-score (PS) matched (1:1) cohort analysis. MEASUREMENTS AND MAIN RESULTS: 123 patients received ECMO. By multivariate analysis, increasing values of age, lactate and plateau pressure under ECMO were associated with death. Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one matching and using controls only once. Mortality did not differ between the two matched cohorts (OR=1.48; 95%CI [0.68-3.23], p=0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower PaO2/FiO2 ratio, higher plateau pressure, but also a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%, p=0.005). CONCLUSION: Under ECMO, an ultra protective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe A(H1N1)-related ARDS treated with ECMO were compared to conventionally-treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic and younger ECMO-treated patients had, however, a lower mortality.
Authors:
Tài Pham; Alain Combes; Hadrien Rozé; Sylvie Chevret; Alain Mercat; Antoine Roch; Bruno Mourvillier; Claire Ara-Somohano; Olivier Bastien; Elie Zogheib; Marc Clavel; Adrien Constan; Jean-Christophe Marie Richard; Christian Brun-Buisson; Laurent Brochard;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-15
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Réanimation Médicale, Groupe Hospitalier Henri Mondor, Créteil, France.
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