The evolution of evidence‐based medicine in critical care: have we left ‘time to defecation’ behind?

Bivalirudin in Venovenous Extracorporeal Membrane Oxygenation: Moving Forward in the Real World*

“…The still-fresh frustrations of the ECMO to Rescue Lung Injury in Severe [Acute Respiratory Distress Syndrome] trial failing to achieve statistically meaningful conclusions in the face of high costs, painfully slow enrollment and high cross-over have not left a great appetite for undertaking RCTs. This debate is not unique to the ECMO community but is shared by other branches of medicine such as critical care that suffer from profound difficulty creating large enough and homogeneous enough cohorts to undertake prospectively controlled trials that practitioners are willing to generalize from (14). This increasing acceptance of the necessity of turning toward RWE is evidenced by the Food and Drug Administration’s own published framework for its use (15).…”