Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation
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
Journal: Intensive Care Medicine (2024)

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