A Daily, Respiratory Therapist Assessment of Readiness to Liberate From Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome.

Journal Article (Journal Article)

We assessed the effect of implementing a protocol-directed strategy to determine when patients can be liberated from venovenous extracorporeal membrane oxygenation on extracorporeal membrane oxygenation duration, time to initiation of first sweep-off trial, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and survival to hospital discharge. DESIGN: Single-center retrospective before and after study. SETTING: The medical ICU at an academic medical center. PATIENTS: One-hundred eighty patients with acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation at a single institution from 2013 to 2019. INTERVENTIONS: In 2016, our institution implemented a daily assessment of readiness for a trial off extracorporeal membrane oxygenation sweep gas ("sweep-off trial"). When patients met prespecified criteria, the respiratory therapist performed a sweep-off trial to determine readiness for discontinuation of venovenous extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS: Sixty-seven patients were treated before implementation of the sweep-off trial protocol, and 113 patients were treated after implementation. Patients managed using the sweep-off trial protocol had a significantly shorter extracorporeal membrane oxygenation duration (5.5 d [3-11 d] vs 11 d [7-15.5 d]; p < 0.001), time to first sweep-off trial (2.5 d [1-5 d] vs 7.0 d [5-11 d]; p < 0.001), duration of mechanical ventilation (15.0 d [9-31 d] vs 25 d [21-33 d]; p = 0.017), and ICU length of stay (18 d [10-33 d] vs 27.0 d [21-36 d]; p = 0.008). There were no observed differences in hospital length of stay or survival to hospital discharge. CONCLUSIONS: In patients with acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation at our institution, implementation of a daily, respiratory therapist assessment of readiness for a sweep-off trial was associated with a shorter time to first sweep-off trial and shorter duration of extracorporeal membrane oxygenation. Among survivors, the postassessment group had a reduced duration of mechanical ventilation and ICU lengths of stay. There were no observed differences in hospital length of stay or inhospital mortality.

Full Text

Duke Authors

Cited Authors

  • Pratt, EH; Mausert, S; Wilson, MD; Emerson, LJ; Navuluri, N; Pulsipher, AM; Brucker, A; Green, CL; Bonadonna, DK; Bryner, BS; Rackley, CR

Published Date

  • December 2021

Published In

Volume / Issue

  • 3 / 12

Start / End Page

  • e0584 -

PubMed ID

  • 34881366

Pubmed Central ID

  • PMC8647875

Electronic International Standard Serial Number (EISSN)

  • 2639-8028

Digital Object Identifier (DOI)

  • 10.1097/CCE.0000000000000584

Language

  • eng

Conference Location

  • United States