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.
Single-center retrospective before and after study.
The medical ICU at an academic medical center.
One-hundred eighty patients with acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation at a single institution from 2013 to 2019.
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.
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.