Please select the eligibility criteria that correspond to the clinical trial below.
Title: Extracorporeal Membrane Oxygenation(ECMO) for Severe Acute Respiratory Distress Syndrome (ARDS)
Brief Summary: This international multicenter, randomized, open trial will evaluate the impact of Extracorporeal Membrane Oxygenation (ECMO), instituted early after the diagnosis of acute respiratory distress syndrome (ARDS) not evolving favorably after 3-6 hours under optimal ventilatory management and maximum medical treatment, on the morbidity and mortality associated with this disease.


Options:
A: Inclusion Criteria:

* The trial subjects are patients aged 18 years or older who have developed severe ARDS. Following the American-European Consensus Conference on ARDS, severe ARDS is defined as an oxygenation index (PaO2/FIO2) \< 200 mmHg. These parameters must be present for a duration of at least 2 hours.

Exclusion Criteria:

* age \< 18 years
* decompensated heart insufficiency
* acute coronary syndrome
* severe chronic obstructive pulmonary disease
* advanced tumour conditions with life expectancy \< 6 months
* chronic dialysis treatment
* lung transplant patients
* proven Heparin-induced thrombocytopenia (HIT)
* morbid obesity (BMI \>) 40
* Child Class B and C cirrhosis of the liver, acute fulminant hepatic failure
* severe peripheral arterial occlusive disease (pAVK III - IV), absence of limb doppler pulse
* brain injury (GCS \< 9 + CT pathology)
B: Inclusion criteria :

1. ARDS defined according to the following criteria (9) :

   * Intubation and mechanical ventilation for ≤ 6 days
   * Bilateral radiological pulmonary infiltrates consistent with edema
   * PaO2/FiO2 ratio \< 200 mm Hg
   * Absence of clinical evidence of elevated left atrial pressure and/or pulmonary arterial occlusion pressure ≤ 18 mm Hg
2. One of the 3 following criteria of disease severity:

   i. PaO2/FiO2 \< 50 mm Hg with FiO2 ≥ 80% for \> 3 hours, despite optimization of mechanical ventilation (Vt set at 6 ml/kg and trial of PEEP ≥ 10 cm H2O) and despite possible recourse to usual adjunctive therapies (NO, recruitment maneuvers, prone position, HFO ventilation, almitrine infusion) OR

   ii. PaO2/FiO2 \< 80 mm Hg with FiO2 ≥ 80% for \> 6 hours, despite optimization of mechanical ventilation (Vt set at 6 ml/kg and trial of PEEP ≥ 10 cm H2O) and despite possible recourse to usual adjunctive therapies (NO, recruitment maneuvers, prone position, HFO ventilation, almitrine infusion) OR

   iii. pH \< 7.25 (with PaCO2 ≥60 mm Hg) for \> 6 hours (with respiratory rate increased to 35/min) resulting from MV settings adjusted to keep plat ≤ 32 cm H2O (first, tidal volume reduction by steps of 1 mL/kg to 4 mL/kg then PEEP reduction to a minimum of 8 cm H2O.
3. Obtain informed consent from a close relative or surrogate. Should such a person be absent, the patient will be randomized according to the specifications of emergency consent and the patient will be asked to give his/her consent for the continuation of the trial when his/her condition will allow.

Exclusion criteria :

1. Intubation and mechanical ventilation for ≥ 7 days
2. Age \< 18 years
3. Pregnancy
4. Weight \> 1 kg/cm or BMI \> 45 kg/m²
5. Chronic respiratory insufficiency treated with oxygen therapy of long duration and/or long-term respiratory assistance
6. Cardiac failure requiring veno-arterial ECMO
7. Previous history of heparin-induced thrombopenia
8. Oncohaematological disease with fatal prognosis within 5 years
9. Patient moribund on the day of randomization or has a SAPS II \> 90
10. Non drug-induced coma following cardiac arrest
11. Irreversible neurological pathology, for example, flat EEG tracing cerebral herniation...
12. Decision to limit therapeutic interventions
13. ECMO cannula access to femoral vein or jugular vein impossible.
14. CardioHelp device not immediately available
C: Inclusion Criteria:

* Invasive mechanical ventilation using positive end expiratory pressure (PEEP) ≥ 5cmH2O
* Acute and potentially reversible cause of acute respiratory failure as determined by the treating physician
* Within 48 hours of the onset of hypoxemia as defined by Pa02/Fi02 less than or equal to 20kPA

Exclusion Criteria:

* Age \< 16 years old
* Intubated and mechanically ventilated via an endotracheal or tracheostomy tube ≥ 7 days (168 hours) up to the time of randomisation
* Ability to maintain Vt to ≤ 3ml/kg PBW while maintaining pH ≥ 7.2 as determined by the treating physician
* Receiving, or decision to commence, ECMO in the next 24 hours
* Mechanical ventilation using high frequency oscillation ventilation or airway pressure release ventilation
* Untreated pulmonary embolism, pleural effusion or pneumothorax as the primary cause of acute respiratory failure
* Acute respiratory failure fully explained by left ventricular failure or fluid overload (May be determined by clinical assessment or echocardiography/cardiac output monitoring)
* Left ventricular failure requiring mechanical support
* Contra-indication to limited systemic anticoagulation with heparin
* Unable to obtain vascular access to a central vein (internal jugular or femoral vein)
* Consent declined
* Treatment withdrawal imminent within 24 hours
* Patients not expected to survive 90 days on basis of premorbid health status
* DNAR (Do Not Attempt Resuscitation) order (excluding advance directives) in place
* Severe chronic respiratory disease requiring domiciliary ventilation (except for sleep disordered breathing)
* Severe chronic liver disease (Child Pugh \>11)
* Platelet count \< 40,000 mm3 (Prior to catheter insertion)
* Previously enrolled in the REST trial
* Prisoners
D: Inclusion Criteria:

* All patients admitted to the participating ICUs receiving invasive or non-invasive ventilation will be screened and included in the database.

Exclusion Criteria:

* Age \< 16

Answer: B