%0 Journal Article %T Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome An International Multicenter Prospective Cohort %+ CHU Amiens-Picardie %+ Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV) %A Schmidt, Matthieu %A Pham, Tai %A Arcadipane, Antonio %A Agerstrand, Cara %A Ohshimo, Shinichiro %A Pellegrino, Vincent %A Vuylsteke, Alain %A Guervilly, Christophe %A Mcguinness, Shay %A Pierard, Sophie %A Breeding, Jeff %A Stewart, Claire %A Ching, Simon Sin Wai %A Camuso, Janice M. %A Stephens, R. Scott %A King, Bobby %A Herr, Daniel %A Schultz, Marcus J. %A Neuville, Mathilde %A Zogheib, Elie %A Mira, Jean-Paul %A Roze, Hadrien %A Pierrot, Marc %A Tobin, Anthony %A Hodgson, Carol %A Chevret, Sylvie %A Brodie, Daniel %A Combes, Alain %A Luyt, Charles Edouard %A Lebreton, Guillaume %A Leprince, Pascal %A Brechot, Nicolas %A Franchineau, Guillaume %A Nieszkowska, Ania %A Hekimian, Guillaume %A Martucci, Gennaro %A Bacchetta, Matthew %A Abrams, Darryl %A Parekh, Madhavi %A Trindade, Anil %A Kida, Yoshiko %A Kyo, Michihito %A Shimatani, Tatsutoshi %A Shime, Nobuaki %A Tanigawa, Koichi %A Valchanov, Kamen %A Fowles, Jo-Anne %A Meagher, Louise %A Papazian, Laurent %A Hraiech, Sami %A Forel, Jean Marie %A Parke, Rachael %A Mccarthy, Lianne %A Gilder, Eileen %A Mcgeorge, Alastair %A Jacquet, Luc-Marie %A van Caenegem, Olivier %A Nair, Priya %A Reynolds, Claire %A Forrest, Paul %A Ming, Chan Wai %A Kong, Harriet %A Harmon, Matt %A Bouadma, Lilia %A Timsit, Jean Francois %A Sonneville, Romain %A Dupont, Herve %A Nader, Joseph %A Wasilewski, Marion %A Gilles, David %A Trojette, Faouzi %A Moubarak, Mona %A Caus, Thierry %A Faraone, Espedito %A Smith, Roger %< avec comité de lecture %@ 1073-449X %J American Journal of Respiratory and Critical Care Medicine %I American Thoracic Society %V 200 %N 8 %P 1002-1012 %8 2019 %D 2019 %R 10.1164/rccm.201806-1094OC %Z Life Sciences [q-bio]Journal articles %X Rationale: Current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Objectives: To report current practices regarding mechanical ventilation in patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and their association with 6-month outcomes. Methods: This was an international, multicenter, prospective cohort study of patients undergoing ECMO for ARDS during a 1-year period in 23 international ICUs. Measurements and Main Results: We collected demographics, daily pre- and per-ECMO mechanical ventilation settings and use of adjunctive therapies, ICU, and 6-month outcome data for 350 patients (mean +/- SD pre-ECMO Pa-O2/FIO2 71 +/- 34 mm Hg). Pre-ECMO use of prone positioning and neuromuscular blockers were 26% and 62%, respectively. V-T (6.4 +/- 2.0 vs. 3.7 +/- 2.0 ml/kg), plateau pressure (32 +/- 7 vs. 24 +/- 7 cm H2O), driving pressure (20 +/- 7 vs. 14 +/- 4 cm H2O), respiratory rate (26 +/- 8 vs. 14 = 6 breaths/min), and mechanical power (26.1 +/- 12.7 vs. 6.6 +/- 4.8 J/min) were markedly reduced after ECMO initiation. Six-month survival was 61%. No association was found between ventilator settings during the first 2 days of ECMO and survival in multivariable analysis. A time-varying Cox model retained older age, higher fluid balance, higher lactate, and more need for renal-replacement therapy along the ECMO course as being independently associated with 6-month mortality. A higher VT and lower driving pressure (likely markers of static compliance improvement) across the ECMO course were also associated with better outcomes. Conclusions: Ultraprotective lung ventilation on ECMO was largely adopted across medium- to high-case volume ECMO centers. In contrast with previous observations, mechanical ventilation settings during ECMO did not impact patients' prognosis in this context. %G English %L hal-03572337 %U https://u-picardie.hal.science/hal-03572337 %~ UNIV-PICARDIE %~ U-PICARDIE %~ MP3CV