The Particulars: Several reports have shown that survival can improve with the early use of extracorporeal membrane oxygenation (ECMO) in patients with refractory acute respiratory distress syndrome (RARDS). However, anecdotal evidence suggests that many critical care providers perceive ECMO as a salvage therapy.
Data Breakdown: University of Alabama researchers conducted a national survey to evaluate the treatment modalities used by critical care physicians for RARDS and their perceptions toward using ECMO. More than two-thirds of respondents said EMCO was available in their institution for RARDS, 90% felt early referral to EMCO improved patient outcomes, and more than half said ECMO improved survival in RARDS. However, airway pressure release was the initial choice for RARDS by 42% of respondents, followed by inhaled nitric oxide (28%), prone positioning (18%), and ECMO (12%). More than 80% of respondents said there was a lack of expertise among critical care physicians in managing EMCO.
Take Home Pearls: Critical care providers report that ECMO is widely available at their institution and believe it improves outcomes and survival. However, these providers also report that ECMO is not the first line therapy for RARDS, perhaps due to a lack of training and expertise in this area.