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Oxygenation management during veno-arterial ECMO support for cardiogenic shock: a multicentric retrospective cohort study

Annals of Intensive Care volume 14, Article number: 56 (2024) Cite this article

Abstract

Backgound

Hyperoxemia is common and associated with poor outcome during veno-arterial extracorporeal membrane oxygenation (VA ECMO) support for cardiogenic shock. However, little is known about practical daily management of oxygenation. Then, we aim to describe sweep gas oxygen fraction (FSO2), postoxygenator oxygen partial pressure (PPOSTO2), inspired oxygen fraction (FIO2), and right radial arterial oxygen partial pressure (PaO2) between day 1 and day 7 of peripheral VA ECMO support. We also aim to evaluate the association between oxygenation parameters and outcome. In this retrospective multicentric study, each participating center had to report data on the last 10 eligible patients for whom the ICU stay was terminated. Patients with extracorporeal cardiopulmonary resuscitation were excluded. Primary endpoint was individual mean FSO2 during the seven first days of ECMO support (FSO2 mean (day 1−7)).

Results

Between August 2019 and March 2022, 139 patients were enrolled in 14 ECMO centers in France, and one in Switzerland. Among them, the median value for FSO2 mean (day 1−7) was 70 [57; 79] % but varied according to center case volume. Compared to high volume centers, centers with less than 30 VA-ECMO runs per year were more likely to maintain FSO2 ≥ 70% (OR 5.04, CI 95% [1.39; 20.4], p = 0.017). Median value for right radial PaO2 mean (day 1−7) was 114 [92; 145] mmHg, and decreased from 125 [86; 207] mmHg at day 1, to 97 [81; 133] mmHg at day 3 (p < 0.01). Severe hyperoxemia (i.e. right radial PaO2 ≥ 300 mmHg) occurred in 16 patients (12%). PPOSTO2, a surrogate of the lower body oxygenation, was measured in only 39 patients (28%) among four centers. The median value of PPOSTO2 mean (day 1−7) value was 198 [169; 231] mmHg. By multivariate analysis, age (OR 1.07, CI95% [1.03–1.11], p < 0.001), FSO2 mean (day 1−3)(OR 1.03 [1.00-1.06], p = 0.039), and right radial PaO2 mean (day 1−3) (OR 1.03, CI95% [1.00-1.02], p = 0.023) were associated with in-ICU mortality.

Conclusion

In a multicentric cohort of cardiogenic shock supported by VA ECMO, the median value for FSO2 mean (day 1−7) was 70 [57; 79] %. PPOSTO2 monitoring was infrequent and revealed significant hyperoxemia. Higher FSO2 mean (day 1−3) and right radial PaO2 mean (day 1−3) were independently associated with in-ICU mortality.

Background

While Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is primarily used to restore adequate tissue perfusion by increasing systemic blood flow, it also significantly impacts blood oxygenation because of the oxygenator integrated into the circuit. Indeed, severe hyperoxemia (i.e. PaO2 ≥ 300 mmHg) is commonly reported during VA-ECMO support, with prevalence ranging from 12 to 89% during the first 24 h [1,2,3,4,5,6,7,8,9]. Several studies have reported an association between severe hyperoxemia and poor outcome in this population, especially after refractory cardiac arrest [2,3,4,5,6,7, 9,10,11]. In the setting of cardiogenic shock rescued by VA-ECMO, although initial studies did not find such association [1, 7], there is emerging data supporting the link between hyperoxemia and mortality [8, 12, 13].

Based on these observational studies, the 2021 ELSO guidelines have recommended to target slight hyperoxemia after the oxygenator (PPOSTO2 around 150 mmHg) and to avoid hypoxemia on the right radial artery [14]. Such guidelines open to wide variation in clinical practice, as it is still unknown how to reach these oxygenation’s targets. Indeed, because of the dual circulation, right radial PaO2 is impacted by both the ventilator settings (inspired fraction of oxygen (FIO2) and positive end expiratory pressure (PEEP)), the ECMO blood flow, and the sweep gas oxygen fraction (FSO2) [15, 16].

To date, there is very limited data on oxygenation management during VA-ECMO support for cardiogenic shock, all studies reporting monocentric or bicentric experiences, and limited to the first 24 h [7, 8], 48 h [12], or 72 h [1]. Then, we aimed to describe the current oxygenation management for the first week of VA ECMO support in a multicentric cohort of patients with cardiogenic shock. We also aimed to evaluate the association between oxygenation parameters and outcome.

Methods

This was a retrospective cohort multicentric study conducted in 14 intensive care units (ICU) in France, and one ICU in Switzerland. The study was approved by our institutional review board in august 2021 (“ECMOxy: oxygenation practice in patients with cardiogenic shock supported by VA ECMO”, approval number EI/2021/1061). This was considered as a multicentric Evaluation of Professional Practices. Aiming at improving quality of care, this French legal framework allows collection of anonymized data related to standard care without need of written patient’s consent. However, in Switzerland, the consent of the patient or his surrogate was mandatory. The research was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments.

Patients

Inclusion criteria were adult patients, supported by VA-ECMO for refractory cardiogenic shock, and having available data on FSO2 from the day of implantation (day 1) to day 7 (or the day of weaning if before day 7). Exclusion criteria were extracorporeal cardiopulmonary resuscitation (ECPR), and ECMO duration less than 24 h. Each participating center had to report data on the last 10 eligible patients for whom the ICU stay was terminated.

Data collection

The following data were collected: demographic data, characteristic of centers, indication for VA-ECMO support, VA-ECMO configuration, Simplified Acute Physiology Score 2 (SAPS2) and Sequential Organ Failure Assessment (SOFA) score, data related to extracorporeal oxygenation (FSO2 two times daily, and postoxygenator oxygen partial pressure (PPOSTO2) if available), data related to systemic oxygenation (FIO2, oxygen partial pressure on the right radial artery (PaO2), tidal volume, PEEP, and extubation), and data related to clinical outcome (need for renal replacement therapy, ECMO duration, ECMO weaning, LVAD implantation, heart transplantation, and in-ICU mortality, i.e. death during the same ICU stay than ECMO canulation). Oxygenation related data were reported from day 1 to day 7 of VA-ECMO support (or the day of weaning if before day 7).

Endpoints

Primary endpoint was individual mean FSO2 during the seven first days of ECMO support (FSO2 mean (day 1−7)). Secondary endpoints were individual mean FSO2 during the three first days (FSO2  mean (day 1−3)), individual mean right radial PaO2 during the seven first days (right radial PaO2 mean (day 1−7)), prevalence of PPOSTO2 monitoring, prevalence of extubation, and factors associated with in-ICU mortality.

Statistical analysis

According to a Shapiro test, the studied variables were not normally distributed. Quantitative parameters were then described as median [Interquartile range] and number (percentage). FSO2 was dichotomized at the median value in the overall population (70%).

First, univariate analysis was performed to identify factors significantly associated with FSO2 mean (day 1-7) ≥ 70% and with in-ICU mortality. Wilcoxon test was used to compare quantitative parameters and Chi-square test or Fisher exact test for qualitative parameters. A Wilcoxon signed rank test was used to compare repeated variables.

Second, we performed a multivariate logistic regression analysis to identify factors independently associated with FSO2 mean (day 1-7) ≥ 70%. Variables associated with FSO2 mean (day 1-7) ≥ 70% with a p value of less than 0.1 by univariate analysis were introduced in the model.

Third, we performed a multivariate logistic regression analysis to identify factors associated with in-ICU mortality. We entered factors associated with in-ICU mortality identified by univariate analysis as well as the duration of ECMO given its potential relevance. We then proceeded to a stepwise AIC backward regression. Multicollinearity between variables of the model was assessed using variance inflation factors. We evaluated the goodness of fit of logistic regression models with a Hosmer Lemeshow test. In case of missing data, no imputation was carried out because they were below 5%. A p value of less than 0.05 was considered statistically significant. Statistical analysis was performed with R version 4.0.3.

Results

Patients and centers

The first patient received VA ECMO in August 2019 and the last in March 2022. Although it was asked to report data for 10 patients, three centers reported data for 5 (5 consent withdrawals in a center in Switzerland), 9 (1 duplicate), and 11 patients, respectively. Data were available for 145 patients. Because oxygenation physiology is very different in peripheral and central ECMO, we secondarily decided to exclude the 6 patients with central ECMO, and 139 patients were finally analyzed.

Acute coronary syndrome was the main cause of cardiogenic shock (n = 50, 36%), followed by acutely decompensated cardiomyopathy (n = 44, 32%), and postcardiotomy shock (n = 26, 19%). ECMO was mainly inserted through femoral vessels (n = 129, 93%). ECMO was successfully weaned in 100 patients (72%), and 87 patients were discharged alive from ICU (63%). Baseline patient’s characteristics are reported in Table 1. Among the 15 participating centers, 4 used to manage less than 30 VA-ECMO patients/year, 9 between 30 and 100 VA ECMO patients/year, and 2 used to manage more than 100 VA ECMO patients/year.

Table 1 Baseline characteristics
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Oxygenation management

FSO2

Among the 139 patients, the median value for FSO2 mean (day 1−7) was 70 [57; 79] % and FSO2 did not differ between day 1 and day 3 (Wilcoxon signed rank test, p = 0.37). However, FSO2 mean (day 1−7) varied between centers, ranging from 46 [43; 58] % to 84 [80; 92] %. Regarding to center case-volume, FSO2 mean (day 1−7) was 72 [70; 81] %, 69 [57; 78] %, and 55 [44; 69] % in centers managing < 30, between 30 and 100, and > 100 VA ECMO per year, respectively (p < 0.01). FSO2 mean (day 1−7) was 66 [50; 76] % in patients extubated during ECMO support, and 70 [59; 80] % in non-extubated patients (p = 0.04). In the whole cohort, 24 patients (17%) experienced at least one day with a FSO2 set at 100%. Descriptive data on oxygenation parameters are summarized in Table 2.

Table 2 Description of oxygenation parameters among the 139 patients supported by peripheral VA ECMO
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By univariate analysis, center case-volume (p = 0.01), and right radial PaO2 mean (day 1−7) (p < 0.01) were associated with FSO2 mean (day 1−7) ≥ 70%. By multivariate analysis, centers with case-volume < 30 per year (OR 5.04, CI 95% [1.39; 20.4], p = 0.017), and right radial PaO2 mean (day 1−7) (OR 1.01, CI 95% [1.00; 1.02], p = 0.006) were associated with FSO2 mean (day 1−7) ≥ 70% (Supplementary Table 1).

FIO2

The median value of FIO2 mean (day 1−7) was 44 [35; 57] %. There was no statistically difference in FIO2 according to center case volume (p = 0.18). Median value of FIO2 mean (day 1−7) was 34 [29; 39] % in patients extubated at least one day during ECMO support, and 51 [42; 64] % in non-extubated patients (p < 0.01) (Table 2).

Right radial PaO2

Among the 139 patients, 723 right radial PaO2 values were available during the seven first days of ECMO support. Data were missing for 7 patients, in whom PaO2 was monitored at the left radial artery.

Median value of right radial PaO2 mean (day 1-7) was 114 [92; 145] mmHg. Right radial PaO2 decreased from 125 [86;207] mmHg at day 1, to 97 [81;133] mmHg at day 3 (Wilcoxon signed rank test p < 0.01). Regarding to center case volume right radial PaO2 mean (day 1-7) was 115 [92;155], 116 [96;147] and 98 [87;112] mmHg in centers managing < 30, between 30 and 100, and > 100 VA ECMO per year, respectively (p = 0.04). Right radial PaO2 mean (day 1-7) was 102 [87; 122] mmHg in patients extubated during ECMO support, and 118 [97; 151] mmHg in non-extubated patients (p = 0.01) (Table 2).

Among the 723 available right radial PaO2 values, 77 (11%) and 22 (3%) were ≥ 200 mmHg and ≥ 300 mmHg, respectively. Among the 139 patients, 16 (12%) experienced severe hyperoxemia, defined as at least one episode of right radial PaO2 ≥ 300 mmHg. Daily evolution of right radial PaO2 ranges distribution is reported in Fig. 1. Evolution of right radial PaO2 according to center case volume and outcome is presented in Supplementary Fig. 2.

Fig. 1
figure 1

Right radial PaO2 ranges distribution

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Tidal volume, PEEP, and extubation

On the day of ECMO implantation, 115 patients (83%) were intubated. Among them, median tidal volume and PEEP during the study period were 6.2 [5.7; 6.9] mL/kg of predicted body weight, and 7 [6; 9] cmH2O, respectively. During the seven first days of ECMO support, 47 patients (34%) were extubated at least one day. The median delay between ECMO start and extubation was 1 [0; 2] days.

PPOSTO2

Among the 15 participating ICUs, 8 (53%) did not use to monitor daily PPOSTO2 and had no available data. In the remaining seven, 3 used to measure PPOSTO2 once daily but with FSO2 transiently increased at 100%. This aims at testing the membrane gas transfer capacity, rather than detecting ECMO-induced hyperoxemia of the lower part of the body. In the remaining four centers measuring PPOSTO2 maintaining FSO2 at its actual value, 39 patients (28%) had available data, and median value of PPOSTO2 mean (day 1−7) value was 198 [169; 231] mmHg. Evolution of PPOSTO2 between day 1 and 7 is reported in Supplementary Fig. 1. Out of the 215 available PPOSTO2 values, 142 (66%) were above 150 mmHg. Among the 139 patients of the cohort, 44 (32%) had at least one day with FSO2 ≤ 50% without PPOSTO2 monitoring.

Association of oxygenation parameters and in-ICU mortality

By univariate analysis, age (p < 0.01), SAPS2 score (p < 0.01), FSO2 day 2 (p = 0.02), FSO2 day 3 (p < 0.01), FSO2 mean (day 1−3) (p < 0.01), FSO2 > 70% day 2 (i.e. at least one FSO2 value > 70% on day 2) (p = 0.03), FSO2 > 70% day 3 (p = 0.02), FSO2 > 70% day 1−3 (p = 0.04) and right radial PaO2 mean (day 1−3) (p = 0.01) were associated with in-ICU mortality. We entered 5 variables in the multivariate logistic regression analysis: age, SAPS2, FSO2 mean (day 1−3), and right radial PaO2 mean (day 1−3); the duration of ECMO was also introduced in the model given its clinical relevance. Using a stepwise AIC backward regression analysis, three out of these five variables were conserved in the final model: age (OR 1.07, CI95% [1.03–1.11], p < 0.001), FSO2 mean (day 1−3) (OR 1.03 [1.00-1.06], p = 0.039), and right radial PaO2 mean (day 1−3) (OR 1.03, CI95% [1.00-1.02], p = 0.023). On the contrary, ECMO duration and SAPS2 score were not independently associated with in-ICU mortality, and were therefore removed during the stepwise logistic regression analysis.

Univariate and multivariate analysis of factor associated with in-ICU mortality is reported in Table 3. Day by day comparison of FSO2 according to outcome is presented in Fig. 2.

Table 3 Univariate and multivariate analyses of factors associated with in-ICU mortality among the 139 patients supported by peripheral VA ECMO
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Fig. 2
figure 2

Day by day comparison of FSO2 according to outcome. FSO2 : Sweep gas oxygen fraction

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Discussion

In this multicentric cohort study of cardiogenic shock supported by VA ECMO, results may be summarized as follow: (1) median value of FSO2 mean (day 1−7) was 70 [57; 79] %; (2) PPOSTO2 (a surrogate of lower body PO2) monitoring was infrequent and revealed significant hyperoxemia, and (3) higher FSO2 mean (day 1−3) and right radial PaO2 mean (day 1−3) were independently associated with in-ICU mortality.

Published data on FSO2 management are scarce. Most of studies report either only punctual FSO2 values [17, 18], or protocol for the initial FSO2 setting [1, 2, 5, 6, 19]. In a retrospective monocentric study on 54 patients, median FSO2 decreased from 80% [70–100] at baseline, to 70% [65–80] at 48 h [20]. In another study, mean FSO2 was around 80% between day 1 and day 10 of ECMO support [21]. In the study by Moussa et al., mean FSO2 ranged from 50% to 70% between baseline and day 2 [12]. Our data are in line with the previous studies, showing that FSO2 is usually set around 70%. Interestingly, we found that FSO2 varied inversely with ECMO center case volume. Because right radial PaO2 was also higher in low volume centers, we can hypothesize that low volume centers were more tolerant with hyperoxemia, leading to less down titration of FSO2 compared to most experienced centers. However, such observation needs to be interpreted cautiously because only 23% and 14% of patients were enrolled in low and high-volume centers. Then, this difference may reflect practices of a very few centers rather than a real case volume effect.

Using the threshold of 300 mmHg for the right radial PaO2, we found a quite low prevalence of severe hyperoxemia (12%). Our results are concordant with those of Jentzer et al. who found a 19.8% prevalence of severe hyperoxemia 24 h after ECMO start for cardiogenic shock [8]. This observation should probably be linked to an early FSO2 titration, as only 17% of patients of our cohort experienced at least one day with a FSO2 set at 100%.

Although PPOSTO2 was a main objective of the study, we found that PPOSTO2 monitoring was infrequent. It is important to distinguish PPOSTO2 monitoring, i.e. PO2 monitoring of the blood reinjected in the abdominal aorta which can be assimilated to the hepato-splanchnic PO2 monitoring, and functional membrane assessment evaluated once daily by increasing FSO2 transiently at 100% to determine the gas transfer capacity of the membrane. Some clinicians may consider PPOSTO2 monitoring useless, as right radial PaO2 may be sufficient to detect ECMO-induced hyperoxemia, and differential hypoxemia. In the subgroup of patients with available data, we found significant hyperoxemia with a median PPOSTO2 value of 198 mmHg, and two third of values above the ELSO recommended target of 150 mmHg [14]. Previously, only one study on 45 patients has reported data regarding to PPOSTO2. They found that median PPOSTO2 decreased from 301 [215–386] mmHg at baseline, to 140 [78–220] mmHg at H48. In this study, only one third of PPOSTO2 values were below 150 mmHg [20]. A possible reason for this tolerance with hyperoxemia might be the fear of unrecognized hypoxemia of the lower part of the body. Indeed, devices for continuous monitoring of PPOSTO2 or postoxygenator oxygen saturation exist but are not widespread. Then down titration of FSO2 might theoretically result in unknown low PPOSTO2, and hepato-splanchnic hypoxia [15]. One could also argue that for now, the safe PPOSTO2 target is still unknown, as randomized trials are ongoing [22].

Although in the setting of ECPR, most of studies have reported an association between PaO2 and outcome [2, 4,5,6,7, 9,10,11, 23], results are not so clear for patients with cardiogenic shock supported by VA-ECMO. Based on the ELSO registry, Munshi et al. did not found any association between PaO2 24 h after ECMO start and mortality in the subgroup of 775 patients with cardiogenic shock [7]. In a smaller cohort by Ross et al., mean PaO2 of the 72 first hours was also not associated with mortality [1]. However, more recently, Moussa et al. reported that early hyperoxemia was associated with mortality in a cohort of 430 patients. In this study, mean PaO2, absolute peak PaO2, and mean daily peak PaO2 during the 48 first hours were associated with 28-day mortality [12]. An analysis of 9959 patients in the ELSO registry found an association between hyperoxemia (PaO2 > 150 mmHg 24 h after ECMO start) and in-hospital mortality [8]. Our results are in line with these findings.

Beyond the already described link between PaO2 and outcome, we found that FSO2 mean (day 1−3) was independently associated with in-ICU mortality. Such finding is of interest because it may help to distinguish if hyperoxemia is a culprit or only a covariate [22]. Indeed, such link between hyperoxemia and prognosis might either be mediated by the proper harm of ECMO-associated hyperoxemia or be biased by the severity of cardiac failure. In the setting of peripheral VA-ECMO, the differential hypoxemia phenomenon results in heterogeneous PO2 along the aorta, depending of the location of the mixing zone [24]. In the most severe cardiac failure, the mixing zone is in the aortic arch, close to the brachiocephalic trunk. Then, right radial PaO2 is mainly determined by FSO2, and its value is closed to the PPOSTO2 value. In the absence of measurement of stroke volume or its surrogates (pulse pressure or end tidal CO2 [25]), we cannot rule out that patients with higher right radial PaO2 were those with the most severe cardiac failure, having per se a higher mortality [26]. The fact that a higher FSO2 mean (day 1−3) was independently associated with a higher in-ICU mortality supports the hypothesis of the proper harm of ECMO-induced hyperoxemia, as FSO2 may not be impacted by cardiac failure severity. Indeed, higher FSO2 mean (day 1−3) may have resulted in higher PPOSTO2, and potentially more reperfusion injury of the gut [27], liver, and kidneys. Interestingly, in the study of Moussa et al., the mean FSO2 was lower in survivors than in non-survivors [12]. In the study of Justus et al., the median FSO2 also tended to be lower in survivors than in non-survivors (72% versus 78%) [21].

Our study has strengths. First, the multicentric design allowed us to detect a signal of variability of oxygenation practices according to center’s case volume. Second, we collected data during seven days after ECMO implantation, which corresponds to almost the whole duration of VA-ECMO support. We think that it is more adapted to study the real impact of ECMO-induced hyperoxemia than focusing on the first 24 h of support.

Our study has also several limitations. First, while we hypothesized that the association between FSO2 mean (day 1−3) and in-ICU mortality was mediated by the PPOSTO2 value, we were unable to confirm it because PPOSTO2 monitoring was infrequent, even in high-volume centers. We also did not collect data on ECMO blood flow, which has been recently demonstrated to be a major determinant of right radial PaO2 [20]. Because the primary objective of the study was description of oxygenation practices, we also did not collect data allowing to evaluate the impact of ECMO-induced hyperoxemia on organ dysfunction. Second, our study was mostly conducted in France. Epidemiological data from another country may have led to different observation. Third, we did not find any association between centers case volume and in-ICU mortality. It is however commonly admitted that center’s case volume is associated with improved outcome [28]. These results might be explained by the limited sample size, the fact that most of patients were admitted in medium volume centers, and the short-term outcome (in-ICU mortality). Finally, due to the inclusion criteria (last 10 patients with cardiogenic shock supported VA ECMO for more than 24 h), data may reflect oxygenation practices over up to two years in low volume centers, compared to only 3 months in high volume centers.

Conclusion

In a multicentric cohort study of cardiogenic shock supported by VA ECMO, median value of FSO2 mean (day 1−7) was 70 [57; 79] %. PPOSTO2 monitoring was infrequent but revealed significant hyperoxemia. Higher FSO2 mean (day 1−3) and right radial PaO2 mean (day 1−3) were independently associated with in-ICU mortality. Based on these results, we can hypothesize that a strategy of systematic daily monitoring of PPOSTO2 may help to down titrate FSO2 and reduce ECMO-associated hyperoxemia and its potential deleterious effects.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Service de réanimation médicale, CHU Besançon, Besançon, France

    Hadrien Winiszewski, Thibault Vieille, Mael Le Berre, Gael Piton & Gilles Capellier

  2. Service d’anesthésie-réanimation chirurgicale, CHU Dijon, Dijon, France

    Pierre-Grégoire Guinot

  3. Department of Anesthesia and Critical Care, University Hospital of Rennes, Pontchaillou, Rennes, France

    Nicolas Nesseler

  4. Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France

    Laure Crognier

  5. Anesthesia, Intensive Care and Perioperative Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France

    Anne-Claude Roche

  6. Service d’Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France

    Jean-Luc Fellahi

  7. Cardiac Surgery Department, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France

    Nicolas D’Ostrevy

  8. Department of Adult Intensive Care Medicine, Lausanne University Hospital and Lausanne University, Lausanne, 1011, Switzerland

    Zied Ltaief

  9. Service de médecine intensive réanimation, CHU Pitié Salpêtrière, Paris, France

    Juliette Didier

  10. Department of Anaesthesia and Critical Care Medicine, Amiens University Medical Center, Amiens, France

    Osama Abou Arab

  11. Anesthesiology and Critical Care Medicine Department, Hôpital Européen Georges Pompidou, APHP, Paris, France

    Simon Meslin

  12. Department of Anaesthesiology and Critical Care, CHU Rouen, Rouen, F-76000, France

    Vincent Scherrer

  13. Département d’Anesthésie Réanimation Chirurgicale, Université de Franche-Comté, CHU Besançon, CIC Inserm 1431, Besançon, EA3920, F-25000, France

    Guillaume Besch

  14. Service de Médecine Intensive-Réanimation Médicale, CHU Strasbourg, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, 67000, France

    Alexandra Monnier

  15. Service de médecine intensive réanimation, CHU Nancy, Créteil, France

    Antoine Kimmoun

  16. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia

    Gilles Capellier

  17. Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France

    Hadrien Winiszewski

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  1. Hadrien Winiszewski
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  2. Thibault Vieille
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Contributions

HW and GC designed the study and wrote the manuscript; TV and GP performed statistic and reviewed the manuscript; PGG, MLB, NN, TS, ACR, JLF, AM, ZL, JD, OAA, SM, VS, GB, AM, AK collected data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hadrien Winiszewski.

Ethics declarations

Ethics approval and consent to participate

The study was approved by our institutional review board in august 2021 (“ECMOxy: oxygenation practice in patients with cardiogenic shock supported by VA ECMO”, approval number EI/2021/1061). This was considered as a multicentric Evaluation of Professional Practices. Aiming at improving quality of care, this French legal framework allows collection of anonymized data related to standard care without need of written patient’s consent. However, in Switzerland, the consent of the patient or his surrogate was mandatory. The research was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments.

Consent for publication

Because all data are anonymized, consent for publication is not applicable.

Competing interests

The authors declare that they have no competing interests.

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Winiszewski, H., Vieille, T., Guinot, PG. et al. Oxygenation management during veno-arterial ECMO support for cardiogenic shock: a multicentric retrospective cohort study. Ann. Intensive Care 14, 56 (2024). https://doi.org/10.1186/s13613-024-01286-2

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