Summary

Eligibility
for people ages up to 20 years (full criteria)
Location
at UCLA UCSF
Dates
study started
completion around

Description

Summary

ASCEND researchers are partnering with families of children who receive extracorporeal membrane oxygenation (ECMO) after a sudden failure of breathing named pediatric acute respiratory distress syndrome (PARDS). ECMO is a life support technology that uses an artificial lung outside of the body to do the lung's work. ASCEND has two objectives.

The first objective is to learn more about children's abilities and quality of life among ECMO-supported children in the year after they leave the pediatric intensive care unit. The second objective is to compare short and long-term patient outcomes in two groups of children: one group managed with a mechanical ventilation protocol that reserves the use of extracorporeal membrane oxygenation (ECMO) until protocol failure to another group supported on ECMO per usual care.

Details

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 determine 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.

An opportunity to address this question is provided by NHLBI-funded Prone and Oscillation Pediatric Clinical Trial (PROSpect) and the ECMO registry, Extracorporeal Life Support Organization (ELSO). PROSpect is an existing randomized clinical trial testing the impact of supine/prone positioning and conventional mechanical ventilation/high-frequency oscillatory ventilation on short and long-term clinical outcomes in 1,000 children with severe PARDS. PROSpect manages subjects with a rigorous protocol that reserves ECMO for protocol failure. The ELSO Registry includes children receiving usual care ECMO, initiated at the discretion of the intensivist.

ASCEND harmonizes PROSpect and ELSO data collection and prospectively measures functional status and quality of life via surveys in an additional 550 children with severe PARDS from ELSO sites. ASCEND measures children's abilities and quality of life when the child was in their normal state of health (just prior to being hospitalized), at discharge from the pediatric intensive care unit, and at 1-month, 3-months, 6-months, and 12-months after discharge from the pediatric intensive care unit. After enrollment of the usual care ECMO (in ELSO) and PROSpect's protocolized therapies (from the PROSpect clinical trial) is complete, then ASCEND will match similarly critically ill children based on their propensity to receive usual care ECMO.

ASCEND combines real-world observational data (from ELSO) and a randomized clinical trial (from PROSpect) to address two specific aims.

Aim 1: The study 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: The study 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.

Protocol change in November 2021:

Inclusion criteria: Extend the window between intubation and ECMO cannulation from 120 hours to 168 hours.

Exclusion criteria: Remove active air leak, critical airway, and facial surgery/trauma within the last 2 weeks.

Protocol change in October 2022:

Inclusion criteria:

  1. Extended the age range from 14 days - 17 years to 14 days - 20 years of age.
  2. Extended the window between intubation and ECMO cannulation from 168 hours to 240 hours.

Keywords

Acute Respiratory Distress Syndrome, Extracorporeal Membrane Oxygenation, ARDS, ECMO, Extracorporeal Life Support, ECLS, Pediatric, Quality of Life, Functional Status, Respiratory Distress Syndrome, Newborn Respiratory Distress Syndrome, Acute Lung Injury, ECMO support, PROSpect protocolized therapies

Eligibility

You can join if…

Open to people ages up to 20 years

  • Time between intubation and ECMO cannulation is less than 240 hours (10 days)
  • ECMO support type is respiratory (VV or VA cannulation)
  • Chest radiograph with bilateral lung disease
  • Moderate or severe pediatric ARDS as measured by oxygenation index or oxygen saturation index after intubation and prior to ECMO cannulation:

One OI ≥ 16 or Two OIs ≥ 12 and ≤ 16 at least four hours apart or Two OSIs ≥ 10 at least four hours apart or One OI ≥ 12 and ≤ 16 and One OSI ≥ 10 at least four hours apart

You CAN'T join if...

  • Previously enrolled in PROSpect
  • Perinatal related lung disease
  • Congenital diaphragmatic hernia or congenital/acquired diaphragm paralysis
  • Respiratory failure caused by cardiac failure or fluid overload
  • Cyanotic congenital heart disease
  • Cardiomyopathy
  • Primary pulmonary hypertension (PAH)
  • Unilateral lung disease
  • Intubated for status asthmaticus
  • Obstructive airway disease
  • Bronchiolitis obliterans
  • Post hematopoietic stem cell transplant
  • Post lung transplant
  • Home ventilator dependent
  • Neuromuscular respiratory failure
  • Head trauma: (managed with hyperventilation)
  • Intracranial bleeding
  • Unstable spine, femur or pelvic fractures
  • Acute abdominal process/open abdomen
  • Family/medical team have decided to not provide full support
  • Enrolled in interventional clinical trial: not approved for co-enrollment; does not include cancer protocols.
  • Known pregnancy

Locations

  • UCLA Mattel Children's Hospital accepting new patients
    Los Angeles California 90095 United States
  • UCSF Benioff Children's Hospital Oakland accepting new patients
    Oakland California 94609 United States
  • UCSF Benioff Children's Hospital - San Francisco accepting new patients
    San Francisco California 94158 United States
  • Children's Hospital of Orange County accepting new patients
    Orange California 92868 United States
  • Valley Children's Hospital accepting new patients
    Madera California 93636 United States
  • Lucile Packard Children's Hospital Stanford accepting new patients
    Palo Alto California 94304 United States

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
University of Michigan
ID
NCT05388708
Study Type
Observational
Participants
Expecting 550 study participants
Last Updated