Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation

• DOI: 10.1007/s00134-024-07564-8
• Publication Date: 2024-08-20T12:02:22Z
• Authors: Aidan Burrell; Michael J. Bailey; Rinaldo Bellomo; Hergen Buscher; Glenn Eastwood; Paul Forrest; John F. Fraser; Bentley Fulcher; David Gattas; Alisa M. Higgins; Carol L. Hodgson; Edward Litton; Emma-Leah Martin; Priya Nair; Sze J. Ng; Neil Orford; Kelly Ottosen; Eldho Paul; Vincent Pellegrino; Liadain Reid; Kiran Shekar; Richard J. Totaro; Tony Trapani; Andrew Udy; Marc Ziegenfuss; David Pilcher; ; Carol L Hodgson; Richard J Totaro; Michael Bailey; Amanda Corley; John Fraser; Alisa 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; Anne-Marie Palermo; Chris Allen; Ubbo Wiersema; Joanne McIntyre; Shailesh Bihari; Joe McCaffrey; Matthew 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; Lucas 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 Doherty; Justine Rivett; Fiona McDonald; Sophie Dohnt; Mahni Foster; Richard Totaro; Heidi Buhr; Jennifer Coles; Ruaidhri Carey; Sally Newman; Claire Reynolds; John Fraser; Andrew Thomas; Rachel Bushell; Dawn Lockwood; Oystein Tronstad; Jiville Latu; India Pearse; Niall D Ferguson; Lehana Thabane; Matthieu Schmidt
• Keywords: Male; Adult; Original; Shock, Cardiogenic; 610; Middle Aged; Heart Arrest; Oxygen; Intensive Care Units; Extracorporeal Membrane Oxygenation; Oxygen Saturation; 617; Humans; Female; Registries; Aged

Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets also lead to harmful episodes of hypoxaemia. In this registry-embedded, multicentre trial, we randomly assigned adult patients VA-ECMO in an intensive care unit (ICU) either a conservative (target SaO2 92–96%) or liberal strategy 97–100%) through controlled administration via the ventilator and ECMO gas blender. The primary outcome was number ICU-free days day 28. Secondary outcomes included 60, mortality, ventilation duration, ICU hospital lengths stay, functional at 6 months. From September 2019 June 2023, 934 who received were reported EXCEL registry, whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) recruited. We randomised 149 151 strategy. median 28 similar both groups (conservative: 0 [interquartile range (IQR) 0–13.7] versus liberal: [IQR 0–13.7], treatment effect: [95% confidence interval (CI) – 3.1 3.1]). Mortality (59/159 [39.6%] vs 59/151 [39.1%]) 60 (64/149 [43%] 62/151 [41.1%] groups, as all other secondary adverse events. group experienced 44 (29.5%) major protocol deviations compared 2 (1.3%) (P < 0.001). adults ICU, strategy, did not affect