FIRST-ABC Trial

JAMA

April 7, 2022

Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Following Extubation on Liberation from Respiratory Support in Critically Ill Children.

What was the research question?

In critically ill children who were assessed to be needing a non-invasive respiratory support within 72 hours post extubation (population), is the first-line use of HFNC at 2 L/kg/min (intervention) non inferior to CPAP at 7-8 cm H2O (comparator) in terms of time to liberation from all forms of respiratory support (outcome)?


How did they do it?

A pragmatic, open label, multi-center, parallel group, non-inferiority trial 22 pediatric intensive care units in the United Kingdom that randomized children of the study in a 1:1 ratio to receive HFNC versus CPAP.


What did they find?

553 children out of 600 were randomized to HFNC (281) or CPAP (272).  Median age was 3 months and 44% were girls. Median time to liberation was 50.5 hours for HFNC compared to 42.9 hours for CPAP (adjusted HR, 0.83; 1-sided 97.5% CI, 0.70-∞) indicating that HFNC failed the noninferiority testing in this trial. Mortality at day 180 as a secondary outcome measure was 5.6% in HFNC versus 2.4% in CPAP (adjusted odds ratio, 3.07 [95% CI, 1.1-8.8]). However, mortality at PICU discharge was not different and the number of the specimen is relatively low.


What does it mean?

The study failed to show a noninferiority of HFNC compared to CPAP. This study is likely to have a high impact on the choice of respiratory support after extubation in favor of CPAP in young children.

FIRST-ABC Trial