~103 spots leftby Jul 2027

ECMO-Free Protocol for Extracorporeal Membrane Oxygenation Management

Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Vanderbilt University Medical Center
Disqualifiers: Pregnancy, Prisoner, Under 18, others
No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial aims to test a routine for checking if patients on a life-support machine can safely stop using it. The goal is to improve patient outcomes and reduce costs. The study will compare this routine to the usual care methods.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the ECMO-free protocol treatment?

The research suggests that implementing a protocol-directed strategy for weaning patients from venovenous extracorporeal membrane oxygenation (VV-ECMO) can potentially reduce the duration of ECMO support and improve outcomes like ICU and hospital length of stay, as well as survival to hospital discharge.12345

Is the ECMO-Free Protocol generally safe for humans?

The safety of weaning from ECMO (a machine that helps with breathing and heart function) is not well-studied, and there are no standardized guidelines for safely stopping its use. However, the process is expected to reduce risks and costs if done safely, but more research is needed to understand how to do this effectively.13678

How is the ECMO-free protocol treatment different from other treatments for managing ECMO?

The ECMO-free protocol is unique because it focuses on safely weaning patients from venovenous extracorporeal membrane oxygenation (VV-ECMO) by assessing their ability to tolerate noninjurious mechanical ventilation without the need for ECMO support. Unlike other treatments, this protocol aims to standardize the weaning process, which currently varies widely between centers and is often based on expert opinion rather than clinical evidence.12345

Research Team

JD

Jonathan D Casey, MD, MSc

Principal Investigator

Vanderbilt University Medical Center

Eligibility Criteria

This trial is for adult patients currently receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) in a participating hospital unit. It's not open to pregnant women, prisoners, minors under 18 years old, those on ECMO for over 24 hours, or individuals using it as a bridge to transplant.

Inclusion Criteria

You are currently receiving a special type of life support called VV-ECMO.
Patient is located in a participating unit of an adult hospital

Exclusion Criteria

Patient is pregnant
Patient is a prisoner
Patient is < 18 years old
See 3 more

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Randomization and Initial Assessment

Participants are randomized to either the ECMO-free protocol or usual care group and initial assessments are conducted

1 week
1 visit (in-person)

Intervention

Daily protocolized assessments of readiness for liberation from VV-ECMO are conducted for the ECMO-free protocol group, while usual care is provided to the control group

Until decannulation or death

Follow-up

Participants are monitored for safety and effectiveness after decannulation

60 days

Treatment Details

Interventions

  • ECMO-free protocol (Procedure)
  • Usual Care (Other)
Trial OverviewThe study compares two approaches: the 'ECMO-free protocol' which involves daily assessments to determine if patients can safely stop using VV-ECMO versus 'Usual Care' where there isn't a set protocol for weaning off. The goal is to see if structured assessments improve outcomes and reduce time on ECMO.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: The ECMO-free Protocol groupExperimental Treatment1 Intervention
For patients assigned to the ECMO-free protocol group, the study personnel will perform the ECMO-free protocol daily from enrollment until the first of death or ECMO decannulation; results will be recorded and shared with the treatment team. Final decisions regarding decannulation will be made by treating clinicians who are aware of the results of daily ECMO-free protocolized assessments.
Group II: The Usual Care GroupActive Control1 Intervention
For patients assigned to the usual care group, ECMO weaning and assessments of readiness for ECMO decannulation will be at the discretion of treating clinicians.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Vanderbilt University Medical Center

Lead Sponsor

Trials
922
Recruited
939,000+
Jeffrey R. Balser profile image

Jeffrey R. Balser

Vanderbilt University Medical Center

Chief Executive Officer since 2009

MD and PhD from Vanderbilt University

Rick W. Wright profile image

Rick W. Wright

Vanderbilt University Medical Center

Chief Medical Officer since 2023

MD from University of Missouri-Columbia

Findings from Research

In a study of 83 patients weaned from VV-ECMO for severe ARDS, higher tidal volume and heart rate during the sweep gas-off trial were associated with a greater risk of unsafe liberation from ECMO, indicating these factors can help predict patient outcomes.
Patients who experienced unsafe liberation had significantly higher inspiratory efforts and longer durations of mechanical ventilation and ICU stays, suggesting that careful monitoring of respiratory mechanics is crucial for safe weaning from VV-ECMO.
Achieving Safe Liberation During Weaning From VV-ECMO in Patients With Severe ARDS: The Role of Tidal Volume and Inspiratory Effort.Al-Fares, AA., Ferguson, ND., Ma, J., et al.[2022]
Implementing a daily assessment protocol for readiness to discontinue venovenous extracorporeal membrane oxygenation (ECMO) significantly reduced the duration of ECMO treatment from an average of 11 days to 5.5 days in patients with acute respiratory distress syndrome, based on a study of 180 patients from 2013 to 2019.
Patients assessed with the new protocol also experienced shorter times to the first sweep-off trial and reduced mechanical ventilation duration, leading to a decreased ICU length of stay, although there were no changes in overall hospital length of stay or survival rates.
A Daily, Respiratory Therapist Assessment of Readiness to Liberate From Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome.Pratt, EH., Mausert, S., Wilson, MD., et al.[2022]
Recent advancements in veno-arterial (VA) and veno-venous (VV) ECMO technology have improved support for patients with severe cardiac and pulmonary failure, making previously untreatable cases manageable.
Weaning from ECMO is crucial and should be considered as soon as patients show signs of recovery, but there are currently no standardized protocols, leading to variability in practices across different medical centers.
Fundamentals of weaning veno-arterial and veno-venous extracorporeal membrane oxygenation.Tsiouris, A., Protos, AN., Saikus, CE., et al.[2023]

References

Achieving Safe Liberation During Weaning From VV-ECMO in Patients With Severe ARDS: The Role of Tidal Volume and Inspiratory Effort. [2022]
A Daily, Respiratory Therapist Assessment of Readiness to Liberate From Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome. [2022]
Fundamentals of weaning veno-arterial and veno-venous extracorporeal membrane oxygenation. [2023]
[Weaning of veno-venous extracorporeal membrane oxygenation: when to use the "resting lung"]. [2022]
How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning. [2022]
Liberation From Venovenous Extracorporeal Membrane Oxygenation for Respiratory Failure: A Scoping Review. [2023]
Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. [2023]
Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation. [2022]