.jpg "Payal Gurnani, PharmD, BCPS, BCCCP, photo")
Payal Gurnani, PharmD, BCPS, BCCCP,
Clinical Pharmacy Specialist, Cardiovascular ICU
Memorial Hermann - The Woodlands Medical Center
The Woodlands, Texas
Disclosure information not submitted.
Lauren Michalak, PA-C
Physician Assistant, Cardiovascular Surgery
Rush University Medical Center
Chicago, Illinois, United States
Disclosure information not submitted.
Deborah Tabachnick, MD
Physician, Cardiovascular Surgery
Rush University Medical Center, Illinois, United States
Disclosure information not submitted.
Michael Kotwas, BS, CCP, LP
Perfusion, Cardiovascular Surgery
Rush University Medical Center, Illinois, United States
Disclosure information not submitted.
Antone Tatooles, MD, FACS, FACCP
Physician, Cardiovascular Surgery
Rush University Medical Center
Chicago, Illinois, United States
Disclosure information not submitted.
Title: Outcomes of Extubated Patients Receiving “Awake” Venovenous Extracorporeal Membrane Oxygenation
Introduction: Patients receive prolonged periods of continuous analgesia, sedation, and paralysis while receiving venovenous extracorporeal membrane oxygenation (VV ECMO) until extubation or de-cannulation. However, cessation of continuous analgesia, sedation, and paralysis in patients with acute respiratory distress syndrome (ARDS) receiving VV ECMO facilitates early extubation, family and provider engagement, nutrition, mobility, and involvement in care. Outcomes associated with an awake ECMO strategy have not been well described in the literature. Therefore, the purpose of this study was to evaluate outcomes in ARDS patients receiving awake VV ECMO.
Methods: This is a retrospective, observational study of patients diagnosed with respiratory failure and failing conventional therapies, who underwent VV ECMO from November 2018 to April 2021. Conventional therapies prior to ECMO cannulation included: lung-protective ventilation, prone positioning, neuromuscular blockade, and volume optimization. Patients initially cannulated for combined cardiorespiratory support were not included in the analysis. The primary outcome was survival to hospital discharge. Secondary outcomes included days requiring ECMO, time from cannulation to extubation, complications, patients requiring tracheostomy, hospital length of stay (LOS), intensive care unit (ICU) LOS, and discharge disposition.
Results: A total of 62 patients were included in this analysis. Coronavirus-19, influenza, and bacterial pneumonia comprised the majority of indications for ECMO. The primary outcome of survival to hospital discharge was 85.5% in the cohort. Median days requiring ECMO was 33.0 [0.0-75.0] and median days from ECMO cannulation to extubation was 6.0 [4.0-11.0]. Three patients received a tracheostomy (4.8%). Bleeding and infection were reported in 80.6% and 82.3% of patients, respectively. ICU LOS was 46.0 days [29.0-90.0] and hospital LOS was 51.0 days [32.0-91.0]. Over half of the patients (51.6%) were discharged to an acute rehabilitation facility and 27.4% were discharged home.
CONCLUSIONS. This study highlights the impact of an awake ECMO approach on survival to hospital discharge. Future studies are needed to evaluate outcomes of this approach as compared to current practice to determine if this should become standard of practice.