Critical Care Explorations (Dec 2021)

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

  • Elias H. Pratt, MD,
  • Sarah Mausert, MBA, RRT-ACCS,
  • Michael D. Wilson, RRT-ACCS, RPFT,
  • Logan J. Emerson, MSRC, RRT-ACCS/NPS, AE-C,
  • Neelima Navuluri, MD,
  • Aaron M. Pulsipher, MD,
  • Amanda Brucker, PhD,
  • Cynthia L. Green, PhD,
  • Desiree K. Bonadonna, MPS, CCP, FPP,
  • Benjamin S. Bryner, MD,
  • Craig R. Rackley, MD

DOI
https://doi.org/10.1097/CCE.0000000000000584
Journal volume & issue
Vol. 3, no. 12
p. e0584

Abstract

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Objectives:. 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.