Free for Weaning ECMO vs Respiratory Driven Study

NCT ID: NCT06876415

Last Updated: 2025-11-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-29

Study Completion Date

2027-09-30

Brief Summary

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In its most severe form, Acute Respiratory Distress Syndrome (ARDS) may require the use of veno-venous ECMO (vvECMO). While the criteria for vvECMO indication, ECMO settings, and ventilator management are relatively well-defined after the publication of the EOLIA trial and subsequent national or international guidelines, few studies have assessed the criteria and methods for weaning from vvECMO. Besides, advances in the understanding of the pathophysiology of mechanical ventilation (MV) weaning process have led to the development of specific monitoring tools for this phase.

Schematically, respiratory drive can be evaluated via the ventilator by measuring the pressure generated during a 100-millisecond expiratory occlusion (P0.1) and respiratory efforts through the measurement of esophageal pressure variation (delta Poeso).

Recent retrospective studies conducted on COVID-19 ARDS patients supported by vvECMO suggest a longer duration of mechanical ventilation for patients whose weaning and decannulation process was "forced," i.e., performed under conditions of significant respiratory drive and effort. High values of P0.1 and delta Poeso were associated with prolonged MV duration. Self-inflicted lung injury (P-SILI) and elevated transpulmonary pressure related to these uncontrolled respiratory efforts likely explain the negative impact on MV duration.

Therefore, this randomized study proposes to assess these monitoring tools, which are regularly used in clinical practice, to guide vvECMO weaning and decannulation decisions.

Detailed Description

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Conditions

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ARDS (Acute Respiratory Distress Syndrome)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Investigators
P0.1 and delta Poeso values will be monitored in a blinded manner by an independent investigator and will not be integrated into the decannulation decision

Study Groups

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ECMO-physio group

Patients undergo the ultimate vvECMO weaning test with minimal ECMO support (ECMO flow ≤ 3 L/min, fresh gas flow ≤ 1 L/min, FiO2 21%) and mechanical ventilation with partial support, allowing spontaneous ventilation. P0.1 and delta Poeso values will be monitored and integrated into the decannulation decision

Group Type EXPERIMENTAL

P0.1 and delta Poeso integration into the decanulation decision

Intervention Type OTHER

P0.1 and delta Poeso integration into the decanulation decision

ECMO-gazo group

Patients undergo the ultimate vvECMO weaning test with minimal ECMO support, similar to the experimental group. P0.1 and delta Poeso values will be monitored in a blinded manner by an independent investigator and will not be integrated into the decannulation decision.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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P0.1 and delta Poeso integration into the decanulation decision

P0.1 and delta Poeso integration into the decanulation decision

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients aged 18 years or older Patient whose trusted person has given consent for participation in the study
* Patient on veno-venous ECMO with weaning criteria, including:
* Resolution of the cause of ARDS
* Absence of hemodynamic instability, defined as norepinephrine dose ≤ 0.5 μg/kg/min for at least 3 hours
* Use of a ventilatory mode that allows spontaneous ventilation (VS-AI, BiPAP, or APRV)
* Maximum inspiratory pressure ≤ 28 cm H2O, with a maximum driving pressure ≤ 15 cm H2O, enabling tidal volumes between 4 and 8 ml/kg of predicted body weight (PBW)
* ECMO membrane sweep flow ≤ 2 L/min
* Patient protected by social security

Exclusion Criteria

* Contraindication to the placement of an esophageal pressure balloon (e.g., esophageal varices, nasal trauma, uncontrolled coagulopathy, severe thrombocytopenia),
* Patient with treatment limitation at the time of inclusion,
* Patient in the time frame of exclusion from another research protocol at the time of consent signing,
* Vulnerable patients: minor, adult patient under guardianship or curatorship, patient deprived of liberty, pregnant or breastfeeding woman.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assistance Publique Hopitaux De Marseille

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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François CREMIEUX

Role: STUDY_DIRECTOR

Assistance Publique - Hôpitaux de Marseille

Locations

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Hospices Civiles de Lyon

Lyon, , France

Site Status RECRUITING

Assistance - Publique Hôpitaux de Marseille

Marseille, , France

Site Status RECRUITING

CHU de Nice

Nice, , France

Site Status RECRUITING

Assistance Publique - Hôpitaux de Paris

Paris, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Sami HRAIECH, M.D., Ph.D

Role: CONTACT

04 91 96 58 35 ext. +33

Christophe GUERVILLY, M.D.

Role: CONTACT

04 91 96 58 35 ext. +33

Facility Contacts

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Jean-Christophe RICHARD, M.D, Ph.D

Role: primary

Sami HRAIECH, M.D, Ph.D.

Role: primary

04 91 96 58 35 ext. +33

Christophe GUERVILLY, M.D.

Role: backup

04 91 96 58 35 ext. +33

Denis DOYEN, M.D

Role: primary

Matthieu SCHMIDT, M.D, Ph.D

Role: primary

Other Identifiers

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ID-RCB

Identifier Type: OTHER

Identifier Source: secondary_id

RCAPHM23_0464

Identifier Type: -

Identifier Source: org_study_id

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