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Role of Extracorporeal Membrane Oxygenation in Management of Refractory ARDS in the Intensive Care Unit: A National Survey on Perspectives of the Adult Critical Care Physicians and Trainees FREE TO VIEW

Nirmal Sharma; Keith Wille; Scott Bellot; Daniel Brodie; Enrique Diaz-Guzman
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University of Alabama at Birmingham, Birmingham, AL

Chest. 2014;146(4_MeetingAbstracts):211A. doi:10.1378/chest.1994642
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: Extracorporeal membrane oxygenation (ECMO) is increasingly being used in patients with refractory acute respiratory distress syndrome (RARDS). Several reports have demonstrated improved survival with early use of ECMO. Management of RARDS varies among critical care providers, many of whom perceive ECMO as a salvage therapy. We conducted a national survey to evaluate the treatment modalities used by critical care physicians for RARDS and their perceptions towards use of ECMO.

METHODS: A survey instrument was developed and validated at our institution in accordance with the guidelines of statistical surveys. It was distributed electronically to all pulmonary and critical care (CC), anesthesia CC, surgical CC, emergency and internal medicine CC programs. A total of 19 questions were included in the survey pertaining to treatment of RARDS, use of ECMO for RARDS and ECMO training in their programs.

RESULTS: Survey was sent to 320 critical care fellowship programs and a total of 327 responses were received: 44% from trainees and 56% from CC faculty. Airway pressure release ventilation was considered as the initial choice of management in RARDS by 42%, followed by inhaled nitric oxide 28%, prone positioning 18% and ECMO by 12% of the respondents. 69% described that ECMO was available at their institution for RARDS. Early referral (<1 week) to ECMO was felt to improve patient outcomes by 90 % of the respondents. 58% responded that ECMO improved survival in RARDS and 68% felt that ECMO was not associated with overt complications in RARDS. Additionally, 80% of the respondents thought that there was lack of expertise amongst critical care physicians in managing ECMO. 70% of the respondents suggested that they had some exposure to ECMO technology though 60% felt it was not sufficient to manage patients on ECMO. 90% respondents answered that ECMO training should be part of the critical care curriculum.

CONCLUSIONS: Our survey results show that although ECMO appears to be widely available in academic institutions with critical care training programs, this technology is not preferred as first line therapy in RARDS. The majority of the respondents felt that there is lack of training and expertise among critical care physicians related to management of patients receiving ECMO support.

CLINICAL IMPLICATIONS: Even though, most programs offer some exposure to ECMO technology, the training is not enough to manage patients placed on ECMO support. Critical care training should include ECMO training as part of the curriculum.

DISCLOSURE: The following authors have nothing to disclose: Nirmal Sharma, Keith Wille, Scott Bellot, Daniel Brodie, Enrique Diaz-Guzman

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