Inflammation During ECMO Therapy and ECMO Weaning

The goal of this interventional clinical trial is to compare patients who undergo ECMO therapy for treatment of acute respiratory distress syndrome (ARDS) and a randomized into one of two possible weaning strategy groups.Group 1: Weaning from ventilator occurs before ECMO weaning.Group 2: Weaning from ECMO occurs before weaning from ventilator.This study investigates which one of these strategies is more indulgent for the lung, and leads to less inflammation and therefore less potential side effects and an overall more favourable clinical course.As a primary criterion, measure of IL-6 in blood samples will beused. As secondary criterions, SOFA score at various time points, ventilation pressures, lung injury score (LIS), length of stay in the intensive care unit, and ventilator-associated pneumonia as well as levels of inflammatory cells and cytokines in both blood samples and bronchoalveolar lavage at different time points will be determined.

Inclusion Criteria:Acute respiratory distress syndrome (ARDS) according to the Berlin Definition (PaO2/FiO2 < 100) and treatment with veno-venous ECMO (vvECMO)Hemodynamic stabilityLung compliance did not change/improved during the last 24 hoursTidal volume did not change/improved during the last 24 hours with a PEEP of 10 cmH20 or aboveConsent of the patient or their legal representativeExclusion Criteria:Age < 18 yearsArtificial ventilation for more than 7 days priorPatient, legal representative or doctors decided against an unrestricted intensive care treatmentPositive pregnancy test at time of screeningCardiac failure requiring veno-arterial ECMO therapyChronic respiratory insufficiency requiring long-term oxygen treatment