Article Figures & Data
Tables
- Table 1
Traumatic conditions respondents think are not amenable for extracorporeal membranous oxygenation in severe acute respiratory distress syndrome
All respondents (n=196) ECMO director (n=8) Trauma surgeon (n=136) Surgical intensivist (n=44) Critical care fellow (n=8) Traumatic condition Traumatic brain injury 60% 38% 64% 55% 25% Spinal injury 25% 13% 24% 30% 13% Blunt chest or abdominal trauma 6% 13% 6% 7% 0% Postsurgical condition (splenectomy, colectomy, etc) 9% 0% 9% 11% 13% Postsurgical condition of thorax (pneumonectomy, etc) 9% 38% 7% 11% 13% - Table 2
Ranking of preference of additional treatments for patients with severe acute respiratory distress syndrome who fail conventional mechanical ventilation
Rank (all respondents) Modality Respondents that use modality (%) ECMO directors ranking Trauma surgeons ranking Surgical
intensivists ranking1 APRV 82.0% APRV APRV APRV 2 Bilevel 71.4% Prone Paralysis Bilevel 3 Paralysis 83.0% Paralysis Bilevel Paralysis 4 Prone 86.9% NO Prone Prone 5 NO 75.7% Bilevel NO Epo 6 Epo 59.2% Epo HFOV NO 7 HFOV 61.7% HFOV Epo HFOV 8 Steroids 60.2% Steroids Steroids Steroids 9 Surfactant 44.2% Surfactant Surfactant Surfactant APRV, airway pressure release ventilation; Epo, epoprostenol; HFOV, high-frequency oscillatory ventilation; NO, nitric oxide; bilevel, bilevel ventilation; paralysis, pharmacological paralysis; prone, prone positioning; steroids, corticosteroids.
- Table 3
Timing of when to initiate extracorporeal membranous oxygenation.
All respondents ECMO directors (n=8) Trauma surgeons (n=131) Surgical intensivist (n=42) Critical care fellows (n=8) Timing of ECMO initiation Failure to improve after maximizing conventional ventilation 13.1% 25.0% 12.2% 7.1% 37.5% Failure to improve after APRV/bilevel 23.1% 0.0% 23.7% 33.3% 0.0% Failure to improve after addition of prone, NO, Epo, steroids and/or surfactant 16.6% 25.0% 16.0% 16.7% 25.0% Hypoxic respiratory failure worsening but prior to maximal therapy being reached 28.6% 50.0% 26.7% 28.6% 12.5% I never consider ECMO 10.6% 0.0% 12.2% 11.9% 0.0% I do not know 8.0% 0.0% 9.2% 2.4% 25.0% APRV, airway pressure release ventilation;ECMO, extracorporeal membranous oxygenation; Epo, epoprostenol; HFOV, high-frequency oscillatory ventilation; NO, inhaled nitric oxide; bilevel, bilevel ventilation; paralysis, pharmacological paralysis; prone, prone positioning; steroids, corticosteroids.
- Table 4
Use of VV versus VA extracorporeal membranous oxygenation other than for acute respiratory distress syndrome
VV ECMO only VA ECMO only Initiate VV and transition to VA as needed Don’t know Would not use ECMO Condition for ECMO Hypoxia from pulmonary embolus 19.2% 7.9% 37.9% 26.6% 8.5% Right heart failure from pulmonary embolus 9.7% 29.1% 25.1% 28.0% 8.0% Right heart failure from traumatic pneumonectomy 11.0% 24.9% 26.6% 30.6% 6.9% Hypoxia from pulmonary contusion 37.6% 2.3% 29.5% 24.3% 6.4% Supportive ‘bridge’ after cardiac arrest from hypoxia/right heart failure 6.5% 22.6% 22.0% 33.3% 15.5% ECMO, extracorporeal membranous oxygenation; VA, venoarterial; VV, venovenous.
