Hey folks, Scott Wong are here and this is an M-Crit Wee.

Yesterday, I put out an episode of my buddy Sam Galley on when to use APRV and we got

two great comments almost immediately from really fantastic folks in the ED critical care

community.

I wanted to go through their two comments here on a quick M-Crit Wee because I think

there's some really interesting stuff to discuss.

First ones from my buddy Joe Scheiber, Joe's a intensivist and the head of the ECMO program

down at one of the hospitals in Florida and he'll be on the show very shortly.

We already recorded the episode, but I guess I'll read Joe's comments and then interspersed

my own feelings on it.

All right, over the last five years, every consult I've had for VV ECMO due to ARDS has

been on the ARDS net regimen, most paralyzed, deeply sedated and requiring pressers.

We have used APRV to avoid ECMO in almost all cases when not already dying or in extremists

from hypoxemia, IEPO2 in the thirties.

So we have only calculated one out of every five consults and have an 80% survival rate.

This data includes COVID-19 as well as trauma patients whose family withdrew care due to

severe TBI despite excellent lung recovery.

They're by indicating that the survival rate might even be better than seen in that statistic

is interspersing my own comment there.

Our actual quote-unquote failure rate of APRV, meaning it was applied when already meeting

the criteria for severe ARDS and now ECMO.

So they met ECMO criteria, but not actively dying, meaning they had 12 to 24 hours to

...