Listen to experts discuss VENT-AVOID, a technique to avoid invasive ventilation in COPD exacerbations. Explore the future of ECMO management and the challenges of clinical trials. Dive into the efficiency and risks of CO2 removal in medical procedures, clinical trial outcomes, and managing bleeding complications in ECMO and dialysis.
Clinical trial showed numerical increase in ventilator-free days with ECOR compared to standard care.
43% of ECOR patients experienced non-serious adverse events related to bleeding.
Advancements in ECOR technology and patient selection criteria needed to minimize complications.
Deep dives
Primary Outcome: Ventilator-Free Days
The primary outcome of the trial focused on ventilator-free days at five days after randomization. Surprisingly, not many patients ended up being intubated in either the standard of care or ECOR group, with a notable numerical increase in ventilator-free days with ECOR compared to standard care, although this difference was not statistically significant (p=0.21).
Adverse Events: Bleeding Complications
The trial highlighted a significant number of adverse events related to ECOR, with about 43% of ECOR randomized patients experiencing non-serious adverse events and about 39% experiencing serious adverse events. The majority of these adverse events were related to bleeding, including cannulation site bleeding, hemorrhages, and thrombocytopenia.
Future Directions: Improving Technology and Patient Selection
The trial results suggest the need for advancements in ECOR technology and better patient selection criteria to minimize complications and enhance the risk-benefit profile of the intervention. It's emphasized that ongoing interest in this area may yield improved safety measures and potentially shift the balance towards more benefits than harms.
Challenges in Study Design and Feasibility
Reflecting on the trial's design and feasibility, questions are raised regarding the optimal study design to answer questions related to ECMO and ECOR. The challenge lies in enrolling the right patients and demonstrating separation between groups. The need for feasible clinical trials to address meaningful questions in ECMO is crucial.
Optimistic Outlook and the Role of Clinical Trials
Amidst discussions on patient selection and trial outcomes, the importance of clinical trials in improving ECMO and ECOR interventions is underscored. The evolving technology and strive for better risk-benefit ratios highlight the significance of ongoing research and advancement in critical care practices.
Episode 33! In this episode we are excited to be joined by Eddy Fan and Whitney Gannon, two extraordinary ECMO researchers to talk about VENT-AVOID or " Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease" published March 2024 by Duggal et al in the ATS Blue Journal.
If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
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