Use of ECMO in the Management of Severe Acute Respiratory Distress Syndrome: A Survey of Academic Medical Centers in the United States.
Mortality of severe acute respiratory distress syndrome (ARDS) remains high. Once conventional mechanical ventilation fails, alternative modes of therapy are used; most of which have limited evidence to support their use. No definitive guidelines exist for the management of these patients with alternate modalities of treatment. We conducted a cross-sectional national survey of 302 adult critical care training programs in the United States to understand the current preferences of intensivists regarding the use of different therapies for severe ARDS, including the use of extracorporeal membrane oxygenation (ECMO). A total of 381 responses were received: 203 critical care faculty and 174 critical care trainees. Airway pressure release ventilation was the initial choice of treatment reported by most when conventional mechanical ventilation strategy failed followed by inhaled nitric oxide and prone positioning. Extracorporeal membrane oxygenation availability was reported by 80% of the respondents at their institutions. Most respondents (83%) would consider ECMO in patients who fail optimal mechanical ventilation strategies, and the majority (60%) believed that ECMO use can facilitate lung protective ventilation, but few favored its use as a first-line modality. The majority of respondents reported limited knowledge of ECMO and desired specific ECMO education during training.
From the *Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; †Department of Biostatistics, Ryals School Public Health, University of Alabama at Birmingham, Birmingham, Alabama; ‡Division of Pulmonary, Critical Care, and Sleep Medicine, Columbia University, New York, New York; and §Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
Nirmal S
NS
Sharma
Keith M
KM
Wille
Degui
D
Zhi
Victor J
VJ
Thannickal
Daniel M
DM
Brodie
Charles W
CW
Hoopes
Enrique
E
Diaz-Guzman
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D010865:Pilot Projects; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D014481:United States / Q000453:epidemiology