Please select the eligibility criteria that correspond to the clinical trial below.
Title: pRotective vEntilation With Veno-venouS Lung assisT in Respiratory Failure
Brief Summary: This is a trial of a new way of treating patients with respiratory failure. The investigators propose to deliver a multi-centre clinical trial to determine whether veno-venous extracorporeal carbon dioxide removal (VV-ECCO2R) and lower tidal volume mechanical ventilation improves outcomes and is cost-effective, in comparison with standard care in patients who are mechanically ventilated for acute hypoxaemic respiratory failure


Options:
A: 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
B: Inclusion Criteria:

* Mechanical ventilation with expected duration of \>24h
* Moderate ARDS according to the Berlin definition(16) PaO2/FiO2: 200-100 mmHg, with PEEP ≥ 5 cmH2O

Exclusion Criteria:

* Age \<18 years
* Pregnancy
* Decompensated heart insufficiency or acute coronary syndrome
* Severe COPD
* Major respiratory acidosis PaCO2\>60 mmHg
* Acute brain injury
* Severe liver insufficiency (Child-Pugh scores \>7) or fulminant hepatic failure
* Heparin-induced thrombocytopenia
* Contraindication for systemic anticoagulation
* Patient moribund, decision to limit therapeutic interventions
* Catheter access to femoral vein or jugular vein impossible
* Pneumothorax
* Platelet \<50 G/l
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:

* Adults (presumed or known to be aged 18-75 years, inclusive),
* An initial documented OHCA rhythm of VF/VT,
* No ROSC following 3 defibrillation shocks,
* Body morphology able to accommodate a Lund University Cardiac Arrest System (LUCAS™) automated CPR device, and
* Estimated transfer time from the scene to the ED or CCL of \< 30 minutes.

Exclusion Criteria:

* Age \< 18 years old or \> 75 years old;
* Non-shockable initial OHCA rhythm (pulseless electrical activity \[PEA\] or asystole);
* Valid do-not-attempt-resuscitation orders (DNAR);
* Blunt, penetrating, or burn-related injury, drowning, electrocution or known overdose;
* Known prisoners;
* Known pregnancy;
* Nursing home residents;
* Unavailability of the cardiac catheterization laboratory.
* Severe concomitant illness that drastically shortens life expectancy or increases risk of the procedure;
* Absolute contraindications to emergent coronary angiography including known anaphylactic reaction to angiographic contrast media and/or active gastrointestinal or internal bleeding

Answer: C