A Time to Heal: The EMPROVE Protocol

Grant, April A.; Lineen, Edward B.; Koerner, Michael M.; Vianna, Rodrigo; Loebe, Matthias; Ghodsizad, Ali

doi:10.1111/aor.13365

Cited by 5 publications

(6 citation statements)

References 33 publications

(45 reference statements)

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“…Ventilator management was variable at different institutions with the primary goal of using lung‐protective strategy while oxygenating and ventilating adequately. Prone positioning was utilized aggressively before the institution of ECMO unless rapid deterioration occurred at which point ECMO was initiated 5 . Providing complex therapies such as rescue ECMO during outbreaks of infectious diseases has unique challenges 4 .…”

Section: Discussionmentioning

confidence: 99%

The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience

et al. 2020

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Objective: There is a paucity of clinical data on critically ill patients with requiring extracorporeal life support.Methods: A statewide multi-institutional collaborative for COVID-19 patients was utilized to obtain clinical data on the first 10 critically ill COVID-19 patients who required extracorporeal membrane oxygenation (ECMO).Results: Of the first 10 patients that required ECMO for COVID-19, the age ranged from 31 to 62 years with the majority (70%) being men. Seven (70%) had comorbidities. The majority (80%) of patients had known sick contact and exposure to COVID-19 positive patients or traveled to pandemic areas inside the United States within the 2 weeks before symptom onset. None of the patients were healthcare workers. The most common symptoms leading to the presentation were high fever ≥103°F (90%), cough (80%) and dyspnea (70%), followed by fatigue and gastrointestinal symptoms (both 30%), myalgia, loss of taste, pleuritic chest pain, and confusion (all 10%). All patients had bilateral infiltrates on chest X-rays suggestive of interstitial viral pneumonia. All patients were cannulated in the venovenous configuration. Two (20%) patients were successfully liberated from ECMO support after 7 and 10 days, respectively, and one (10%) patient is currently on a weaning course.One patient (10%) died after 9 days on ECMO from multiorgan dysfunction.Conclusions: These preliminary multi-institutional data from a statewide collaborative offer insight into the clinical characteristics of the first 10 patients requiring ECMO for COVID-19 and their initial clinical course. Greater morbidity and mortality is likely to be seen in these critically ill patients with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience

et al. 2020

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“…Protective lung strategies must be continued whilst on ECMO. The EMPROVE protocol highlights specific ultra‐lung protective strategies that have resulted in survival rates as high as 80% for patients undergoing VV‐ECMO 11 . Their ventilation parameters entailed PIP less than 30 cm H 2 0, PEEP 10 to 14 cm H 2 0, RR 5 to 7 BPM, and FiO 2 less than 50%.…”

Section: Discussionmentioning

confidence: 99%

“…Their ventilation parameters entailed PIP less than 30 cm H 2 0, PEEP 10 to 14 cm H 2 0, RR 5 to 7 BPM, and FiO 2 less than 50%. Similarities from their protocol that we implemented were PIP less than 30 cm H 2 0 and PEEP of 8 to 15 cm H 2 0 11 . However, we used a higher RR to assist with the removal of CO 2 and our FiO 2 levels were dynamic and generally based on the patient's oxygenation status.…”

Section: Discussionmentioning

confidence: 99%

Successful use of VV ECMO in managing negative pressure pulmonary edema

et al. 2020

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The indications for extracorporeal membrane oxygenation (ECMO) are expanding. Postobstructive pulmonary edema, also known as negative pressure pulmonary edema, can result in severe respiratory compromise and acute respiratory distress syndrome. We present a case of a 26‐year‐old female with laryngeal papillomatosis and laryngospasm after direct laryngoscopy, who developed severe NPPE refractory to mechanical ventilator support, which was successfully treated with veno‐venous ECMO.

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“…However, it remains to be seen if an “ultra‐lung protective” strategy employed during ECLS, provides a mortality benefit. The EMPROVE protocol, or ECMO for protective ventilation, is just such an ultralung protective strategy and is described in detail in other publications 4 . In brief, the protocol addresses only the ventilator management and is described in Table 1.…”

Section: Introductionmentioning

confidence: 99%

“…The EMPROVE protocol, or ECMO for protective ventilation, is just such an ultralung protective strategy and is described in detail in other publications. 4 In brief, the protocol addresses only the ventilator management and is described in Table 1. The purpose of this study is to determine if failing to protect the lungs with the EMPROVE protocol increased mortality in patients being treated for ARDS.…”

Section: Introductionmentioning

confidence: 99%

EMPROVING outcomes: Evaluating the effect of an ultralung protective strategy for patients with ARDS treated with ECMO

et al. 2020

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Objective: Since the initiation of an adult extracorporeal membrane oxygenation (ECMO) program at our institution, the program has managed well over 200 patients with ECMO in a 3-year time frame. While there is a plethora of research evaluating ECMO for acute respiratory distress syndrome (ARDS), few studies have evaluated the impact that ventilator management after cannulation might have on outcomes. We hypothesized that failure to properly protect the lungs after cannulation would lead to higher mortality.

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A Time to Heal: The EMPROVE Protocol

Cited by 5 publications

References 33 publications

The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience

The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience

Successful use of VV ECMO in managing negative pressure pulmonary edema

EMPROVING outcomes: Evaluating the effect of an ultralung protective strategy for patients with ARDS treated with ECMO

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