Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation
Aidan Burrell, Michael Bailey, Rinaldo Bellomo, Hergen Buscher, Glenn M. Eastwood, Paul Forrest, John F. Fraser, Bentley J. Fulcher, David Gattas, Alisa M. Higgins, Carol Hodgson, Edward Litton, Emma-Leah Martin, Priya Nair, Sze Ng, Neil Orford, Kelly Ottosen, Eldho Paul, Vincent Pellegrino, Liadain Reid, Kiran Shekar, Richard Totaro, Tony Trapani, Andrew Udy, Marc Ziegenfuss, David Pilcher, Carol Hodgson, Richard Totaro, Michael Bailey, Amanda Corley, John F. Fraser, Alisa M. Higgins, Andrew Hilton, Carol Hodgson, Sze Ng, Richard Totaro, Meredith Young, Jasmin Board, Annalie Jones, Phoebe McCracken, Alastair Brown, Helen Young, Leah Peck, Andrew Hilton, John Dyett, Stephanie Hunter, Cheelim Liew, Kym Gellie, Nicole Robertson, Annemarie Palermo, Chris Allen, Ubbo F. Wiersema, Joanne McIntyre, Shailesh Bihari, Joe McCaffrey, Matthew J. Maiden, Nima Kakho, Allison Bone, Tania Salerno, Michelle Horton, Jemma Trickey, Samantha Breguet, Lucy Range, Meg Gallagher, James Winearls, Mandy Tallott, Maimoonbe Gough, Julie Pitman, James McCullough, Maree Houbert, Lewis McLean, Amber‐Louise Poulter, Sarah Dalton, Jorge Brieva, L.A. Webb, Daniel de Wit, James Walsham, Jason Meyer, Meg Harward, Anand Krishnan, Cassie Jones, Josephine Mackay, Benjamin Reddi, Stephanie O’Connor, Kathleen Glasby, Nerissa Brown, Sarah J. Doherty, Justine Rivett, Fiona McDonald, Sophie Dohnt, Mahni Foster, Richard Totaro, Heidi Buhr, Jennifer Coles, Ruaidhri Carey, Sally Newman, Claire Reynolds, John F. Fraser, A. Thomas, Rachel Bushell
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: 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.