Safety and Feasibility of a Protocolized Daily Assessment of Readiness for Liberation From Venovenous Extracorporeal Membrane Oxygenation.
Clinical Protocols
Critical Care
/ methods
Duration of Therapy
Extracorporeal Membrane Oxygenation
/ methods
Feasibility Studies
Female
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care
Patient Safety
Pilot Projects
Prospective Studies
Risk Adjustment
/ methods
Symptom Assessment
/ methods
Withholding Treatment
/ standards
ECMO
acute lung injury
critical care
extracorporeal membrane oxygenation
pulmonary
respiratory failure
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
19
02
2021
revised:
21
05
2021
accepted:
24
05
2021
pubmed:
25
6
2021
medline:
12
1
2022
entrez:
24
6
2021
Statut:
ppublish
Résumé
Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO. Is a protocolized daily assessment of readiness to liberate from venovenous ECMO safe and feasible? We conducted a prospective, single-arm safety and feasibility study of a protocol for daily assessment of readiness to liberate from venovenous ECMO among consecutive adult patients receiving venovenous ECMO across four ICUs at a single center between June 20, 2020, and November 24, 2020. The ECMO-free protocol included three phases: (1) the safety screening, (2) non-ECMO Fio Twenty-six patients received the ECMO-free protocol on 385 patient-days. The safety screening was passed during a total of 59 ECMO-free daily assessments (15.3%) among 20 patients. Every passed safety screening proceeded to an ECMO-free trial. Twenty-eight passed ECMO-free trials (47.5%) occurred among 16 patients (61.5%). No missed safety screenings, protocol deviations, or adverse events occurred. Of the 16 patients who passed an ECMO-free trial, 14 patients (87.5%) were decannulated. Among decannulated patients, 12 patients (85.7%) were decannulated on the same day as a passed ECMO-free trial, 6 patients (42.9%) were decannulated on the first day that they passed an ECMO-free trial, and 6 patients (42.9%) passed an ECMO-free trial at least twice consecutively before decannulation. The median time from first passed ECMO-free trial to decannulation was 2 days (interquartile range, 0-3 days). The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.
Sections du résumé
BACKGROUND
Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO.
RESEARCH QUESTION
Is a protocolized daily assessment of readiness to liberate from venovenous ECMO safe and feasible?
STUDY DESIGN AND METHODS
We conducted a prospective, single-arm safety and feasibility study of a protocol for daily assessment of readiness to liberate from venovenous ECMO among consecutive adult patients receiving venovenous ECMO across four ICUs at a single center between June 20, 2020, and November 24, 2020. The ECMO-free protocol included three phases: (1) the safety screening, (2) non-ECMO Fio
RESULTS
Twenty-six patients received the ECMO-free protocol on 385 patient-days. The safety screening was passed during a total of 59 ECMO-free daily assessments (15.3%) among 20 patients. Every passed safety screening proceeded to an ECMO-free trial. Twenty-eight passed ECMO-free trials (47.5%) occurred among 16 patients (61.5%). No missed safety screenings, protocol deviations, or adverse events occurred. Of the 16 patients who passed an ECMO-free trial, 14 patients (87.5%) were decannulated. Among decannulated patients, 12 patients (85.7%) were decannulated on the same day as a passed ECMO-free trial, 6 patients (42.9%) were decannulated on the first day that they passed an ECMO-free trial, and 6 patients (42.9%) passed an ECMO-free trial at least twice consecutively before decannulation. The median time from first passed ECMO-free trial to decannulation was 2 days (interquartile range, 0-3 days).
INTERPRETATION
The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.
Identifiants
pubmed: 34166644
pii: S0012-3692(21)01115-6
doi: 10.1016/j.chest.2021.05.066
pmc: PMC8727855
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1693-1703Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL153584
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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