ASCEND ARDS in Children and ECMO initiation strategies impact on Neuro-Development

Project start and end date: September 2020-June 2026

Background:
Decades after extracorporeal membrane oxygenation (ECMO) was first used to support children with severe pediatric acute respiratory distress syndrome (PARDS), pediatric intensivists lack both prospective studies of long-term outcomes in ECMO for PARDS and well-powered studies comparing the impact of ECMO initiation strategies on mortality and morbidity. While clinicians lack the equipoise necessary to randomize ECMO in dying children, there is uncertainty on if and when it is best to initiate ECMO to preserve survival, functioning, and quality of life. To answer the question, if and when ECMO should be initiated in children with severe PARDS, it is necessary to compare the long-term outcomes in ECMO supported children to otherwise similar children who did not receive ECMO at the same threshold if at all.

Objectives:

Aim 1: We will test the hypotheses that one year after children receive usual care ECMO for PARDS, there will be a decline in long-term functional status and health-related quality of life as well as an increase in the proportion of children receiving respiratory support.

Aim 2: We will test the hypotheses that 90-day mortality, one-year functional status, and one-year health-related quality of life are not equivalent for children with usual care ECMO (in ELSO) and PROSpect’s protocolized therapies.

Research Topics:
ECMO, ARDS, Survivorship. 

Methods:
Propensity matching

Implications:
ASCEND will be the first well-powered, prospective evaluation of long-term child-centered outcomes. ASCEND will also be the first well-powered study comparing outcomes in usual care ECMO and maximized conventional therapies that includes ECMO initiation thresholds.

Funder:
NHLBI

Website:
https://ascend.medicine.umich.edu

For more information, please contact:
Clinical Associate Professor, Pediatric Critical Care Medicine
Associate Director for Research, CHEAR
NCRC Building 16, G033N
2800 Plymouth Road
Ann Arbor, MI 48109-2800
Phone
734-615-3388
Email
barbaror@med.umich.edu