Extracorporeal membrane oxygenation (ECMO) and the acute respiratory distress syndrome (ARDS): a systematic review of pre-clinical models

doi:10.1186/s40635-019-0232-7

Review

. 2019 Mar 25;7(1):18.

doi: 10.1186/s40635-019-0232-7.

Extracorporeal membrane oxygenation (ECMO) and the acute respiratory distress syndrome (ARDS): a systematic review of pre-clinical models

Jonathan E Millar^{1

2

3}, Nicole Bartnikowski^{4

5}, Viktor von Bahr^{4

6}, Maximilian V Malfertheiner^{4

7}, Nchafatso G Obonyo^{4

8}, Mirko Belliato⁹, Jacky Y Suen^{4

10}, Alain Combes^{11

12}, Daniel F McAuley¹³, Roberto Lorusso¹⁴, John F Fraser^{4

10}; European Extracorporeal Life Support Organisation (EuroELSO) Innovations Workgroup; National Health Medical Research Council Australia Centre of Research Excellence for Advanced Cardio-respiratory Therapies Improving Organ Support (NHMRC CREACTIONS)

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, 4035 QLD, Australia. j.millar@doctors.org.uk.
² Faculty of Medicine, University of Queensland, Brisbane, Australia. j.millar@doctors.org.uk.
³ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK. j.millar@doctors.org.uk.
⁴ Critical Care Research Group, The Prince Charles Hospital, Brisbane, 4035 QLD, Australia.
⁵ School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Australia.
⁶ Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany.
⁸ Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK.
⁹ U.O.C. Anestesia e Rianimazione 1, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
¹⁰ Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹¹ Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹² Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France.
¹³ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
¹⁴ Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, Netherlands.

PMID: 30911932
PMCID: PMC6434011
DOI: 10.1186/s40635-019-0232-7

Review

Extracorporeal membrane oxygenation (ECMO) and the acute respiratory distress syndrome (ARDS): a systematic review of pre-clinical models

Jonathan E Millar et al. Intensive Care Med Exp. 2019.

. 2019 Mar 25;7(1):18.

doi: 10.1186/s40635-019-0232-7.

Authors

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, 4035 QLD, Australia. j.millar@doctors.org.uk.
² Faculty of Medicine, University of Queensland, Brisbane, Australia. j.millar@doctors.org.uk.
³ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK. j.millar@doctors.org.uk.
⁴ Critical Care Research Group, The Prince Charles Hospital, Brisbane, 4035 QLD, Australia.
⁵ School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Australia.
⁶ Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany.
⁸ Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK.
⁹ U.O.C. Anestesia e Rianimazione 1, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
¹⁰ Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹¹ Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹² Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France.
¹³ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
¹⁴ Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, Netherlands.

PMID: 30911932
PMCID: PMC6434011
DOI: 10.1186/s40635-019-0232-7

Abstract

Objectives: Extracorporeal membrane oxygenation (ECMO) is an increasingly accepted means of supporting those with severe acute respiratory distress syndrome (ARDS). Given the high mortality associated with ARDS, numerous animal models have been developed to support translational research. Where ARDS is combined with ECMO, models are less well characterized. Therefore, we conducted a systematic literature review of animal models combining features of experimental ARDS with ECMO to better understand this situation.

Data sources: MEDLINE and Embase were searched between January 1996 and December 2018.

Study selection: Inclusion criteria: animal models combining features of experimental ARDS with ECMO.

Exclusion criteria: clinical studies, abstracts, studies in which the model of ARDS and ECMO has been reported previously, and studies not employing veno-venous, veno-arterial, or central ECMO.

Data extraction: Data were extracted to fully characterize models. Variables related to four key features: (1) study design, (2) animals and their peri-experimental care, (3) models of ARDS and mechanical ventilation, and (4) ECMO and its intra-experimental management.

Data synthesis: Seventeen models of ARDS and ECMO were identified. Twelve were published after 2009. All were performed in large animals, the majority (n = 10) in pigs. The median number of animals included in each study was 17 (12-24), with a median study duration of 8 h (5-24). Oleic acid infusion was the commonest means of inducing ARDS. Most models employed peripheral veno-venous ECMO (n = 12). The reporting of supportive measures and the practice of mechanical ventilation were highly variable. Descriptions of ECMO equipment and its management were more complete.

Conclusion: A limited number of models combine the features of experimental ARDS with ECMO. Among those that do, there is significant heterogeneity in both design and reporting. There is a need to standardize the reporting of pre-clinical studies in this area and to develop best practice in their design.

Keywords: Acute respiratory distress syndrome; Animal models; Extracorporeal membrane oxygenation; Pre-clinical models; Systematic review.

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The authors declare that they have no competing interests.

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Figures

**Fig. 1**
PRSIMA flow diagram for inclusion and exclusion criteria

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References

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[1] Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–67. doi: 10.1097/MAT.0000000000000475. - DOI - PubMed

[2] Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–67. doi: 10.1097/MAT.0000000000000475. - DOI - PubMed

[3] Schmidt M, Hodgson C, Combes A. Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review. Crit Care. 2015;19(1):99. doi: 10.1186/s13054-015-0806-z. - DOI - PMC - PubMed

[4] Schmidt M, Hodgson C, Combes A. Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review. Crit Care. 2015;19(1):99. doi: 10.1186/s13054-015-0806-z. - DOI - PMC - PubMed

[5] Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. doi: 10.1056/NEJMoa1800385. - DOI - PubMed

[6] Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. doi: 10.1056/NEJMoa1800385. - DOI - PubMed

[7] Máca J, Jor O, Holub M, et al. Past and present ARDS mortality rates: a systematic review. Respir Care. 2017;62(1):113. doi: 10.4187/respcare.04716. - DOI - PubMed

[8] Máca J, Jor O, Holub M, et al. Past and present ARDS mortality rates: a systematic review. Respir Care. 2017;62(1):113. doi: 10.4187/respcare.04716. - DOI - PubMed

[9] Pham T, Rubenfeld GD. Fifty years of research in ARDS. The epidemiology of acute respiratory distress syndrome. A 50th birthday review. Am J Respir Crit Care Med. 2017;195(7):860–870. doi: 10.1164/rccm.201609-1773CP. - DOI - PubMed

[10] Pham T, Rubenfeld GD. Fifty years of research in ARDS. The epidemiology of acute respiratory distress syndrome. A 50th birthday review. Am J Respir Crit Care Med. 2017;195(7):860–870. doi: 10.1164/rccm.201609-1773CP. - DOI - PubMed

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Extracorporeal membrane oxygenation (ECMO) and the acute respiratory distress syndrome (ARDS): a systematic review of pre-clinical models

Affiliations

Extracorporeal membrane oxygenation (ECMO) and the acute respiratory distress syndrome (ARDS): a systematic review of pre-clinical models

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

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Cited by

References

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Abstract

Conflict of interest statement

Ethics approval and consent to participate

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Competing interests

Publisher’s Note

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References

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