{
    "abstract": "There is a paucity of evidence around strategies to liberate patients from veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute respiratory failure.\nThe primary aim of this study was to determine if adopting standardized liberation trials (SLTs) for V-V ECMO is associated with duration of ECMO. The secondary aim was to identify factors associated with unsafe liberation, and the effects of unsafe liberation on mortality to ICU discharge.\nThis was a single centre retrospective cohort study of patients on V-V ECMO for severe respiratory failure comparing endpoints between intervention (SLT) and control (no SLT) periods.\nA total of 262 patients were included in the study, 13% (35/262) received SLTs, and 150 patients were decannulated from ECMO. Implementing SLTs was strongly associated with the duration of V-V ECMO to first successful liberation trial (HR 1.88, 95% CI 1.16-3.06, p = 0.01) and decannulation (HR 1.92, 95% CI 1.0-3.06, p = 0.01) without increasing the frequency of unsafe liberation (SLTs - 21% [5/23]) vs. (No-SLTs - 19% [24/127]) (OR 1.19; 95% CI - 0.4-3.5, p = 0.7). Unsafe liberation was strongly associated with ICU mortality (HR 4.15, 95% CI 1.24-13.9, p = 0.02). Factors associated with unsafe liberation were respiratory rate (OR 1.49 per 5 breaths/min increase, 95% CI 1.07-2.08, p =0.02) and PaO2/FiO2 (OR 0.73 per 30 mmHg increase, 95% CI 0.57-0.93, p = 0.01) immediately prior to decannulation.\nIncorporating SLTs was significantly associated with duration of V-V ECMO without increasing the frequency of unsafe liberation. Unsafe liberation was associated with increased ICU mortality.",
    "authors": [
        {
            "affiliation": "University of Toronto, Interdepartmental Division of Critical Care Medicine , Toronto, Ontario, Canada; Ricardo.TeijeiroParadis@uhn.ca.",
            "firstname": "Ricardo",
            "initials": "R",
            "lastname": "Teijeiro-Paradis"
        },
        {
            "affiliation": "Mount Sinai Hospital/Toronto General Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.",
            "firstname": "Laveena",
            "initials": "L",
            "lastname": "Munshi"
        },
        {
            "affiliation": "University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.",
            "firstname": "Niall D",
            "initials": "ND",
            "lastname": "Ferguson"
        },
        {
            "affiliation": "University of Toronto, Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.",
            "firstname": "Kuan",
            "initials": "K",
            "lastname": "Liu"
        },
        {
            "affiliation": "University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.",
            "firstname": "Eddy",
            "initials": "E",
            "lastname": "Fan"
        }
    ],
    "conclusions": "Incorporating SLTs was significantly associated with duration of V-V ECMO without increasing the frequency of unsafe liberation. Unsafe liberation was associated with increased ICU mortality.",
    "copyrights": null,
    "doi": "10.1513/AnnalsATS.202412-1252OC",
    "journal": "Annals of the American Thoracic Society",
    "keywords": [],
    "methods": null,
    "publication_date": "2025-03-05",
    "pubmed_id": "40042540",
    "results": null,
    "title": "Association of Standardized Liberation Trials and Duration of V-V ECMO in Patients with Acute Respiratory Failure.",
    "xml": "<Element 'PubmedArticle' at 0x78850445c220>"
}