Clinical Trials Logo

Clinical Trial Summary

Clinical reasoning and recent data suggest that early use of venovenous extracorporeal membrane oxygenation in refractory respiratory failure may confer a survival advantage. This retrospective matched study will assess whether patients who received VV ECMO at less severe hypoxaemia had differing outcomes to those who received ECMO with very severe hypoxaemia.


Clinical Trial Description

VV ECMO is increasingly used in refractory respiratory failure. Despite advances in lung protective ventilation strategies, patients who have severe respiratory failure often develop complications from mechanical ventilation, including volutrauma and barotrauma. ECMO allows gas exchange to occur extracorporeally and may reduce the potential burden of iatrogenic lung injury by allowing a reduction of volume and pressure support - a 'lung rest' strategy. It is theorised that earlier intitiation of ECMO may allow for better outcomes, as there will have been less time for iatrogenic lung injury to occur. The UK ECMO registry has been collected of patients treated under the NHS England commissioned respiratory ECMO service since 2011. This study has been previously registered and publication is intended shortly. Patients will be extracted from this registry if they received VV ECMO. Propensity matching scores will be created and patients will be stratified into groups of 'early' vs 'delayed' ECMO, based on their probability of being in either group. Patients will be divided into cohorts based on the median PaO2/FiO2 ratio at decision to cannulate ('less severe hypoxaemia') and ('very severe hypoxaemia'). Matched cohorts will be created correcting for key confounding factors (age, primary diagnosis, duration of pre-ECMO ventilation and PaCO2), using cardinality matching (a novel technique described by Zubizaretta et al. in 2014) and traditional propensity-score-based methods. The technique with greater balance and statistical power (as defined by sample size) will be selected for the primary analysis. Further analyses will assess the relationship between hypoxaemia at decision-to-cannulate and confounding factors as above. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03981393
Study type Observational
Source University of Cambridge
Contact
Status Completed
Phase
Start date December 1, 2011
Completion date March 31, 2018

See also
  Status Clinical Trial Phase
Recruiting NCT05144633 - Blue Protocol and Eko Artificial Intelligence Are Best (BEA-BEST)
Completed NCT04534569 - Expert Panel Statement for the Respiratory Management of COVID-19 Related Acute Respiratory Failure (C-ARF)
Recruiting NCT03021902 - Nutrition and Exercise in Critical Illness Phase 2
Completed NCT02902146 - Bougie Use in Emergency Airway Management N/A
Completed NCT02901158 - Esophageal Manometry in Mechanically Ventilated Patients
Completed NCT02236559 - High Flow Therapy for the Treatment of Respiratory Failure in the ED N/A
Recruiting NCT02056093 - Comparison of Proportional Assist Ventilation And Neurally Adjusted Ventilator Assist N/A
Not yet recruiting NCT01668368 - Goal Directed Mechanical Ventilation Aimed at Optimal Lung Compliance N/A
Terminated NCT01083277 - Variable Ventilation During Acute Respiratory Failure N/A
Completed NCT01462279 - Effect of Thiamine on Oxygen Utilization (VO2) in Critical Illness N/A
Completed NCT01114022 - Prevention Inhalation of Bacterial by Using Endotracheal Tube Balloon Polyvinyl Chloride or Polyurethane N/A
Active, not recruiting NCT01058421 - Treatment of Critical Illness Polyneuromyopathy Phase 2
Completed NCT00252616 - Timing of Target Enteral Feeding in the Mechanically Ventilated Patient Phase 2/Phase 3
Recruiting NCT04098094 - Outcomes of RV Dysfunction in Acute Exacerbation of Chronic Respiratory Diseases
Recruiting NCT06051292 - Decremental Esophageal Catheter Filling Volume Titration For Transpulmonary Pressure Measurement N/A
Completed NCT04601090 - Survival Rates and Longterm Outcomes After COVID-19
Recruiting NCT05423301 - Global Physiotherapy in ICU Patients With High Risk Extubation Failure N/A
Completed NCT02447692 - Proportional Assist Ventilation for Minimizing the Duration of Mechanical Ventilation: The PROMIZING Study N/A
Completed NCT04016480 - HFNC During Bronchoscopy for Bronchoalveolar Lavage N/A
Completed NCT04507425 - High Flow Nasal Cannula With Noninvasive Ventilation N/A