Chugging in patients on veno-venous extracorporeal membrane oxygenation: An under-recognized driver of intravenous fluid administration in patients with acute respiratory distress syndrome?
James M Walter, Chitaru Kurihara, Thomas C Corbridge and 1 others
PMID 29681395WHAT IT FOUND
In an ARDS patient on VV ECMO, repeated albumin boluses for circuit chugging contributed to a roughly 6 liter positive fluid balance.
The authors suggest assessing hypovolemia and reducing pump speed before reflexive fluids.
Key findings
01Frequent albumin boluses for intermittent circuit chugging contributed to a net positive fluid balance of roughly 6 liters 4 days after cannulation.
02Circuit flow improved after intravenous albumin and a decrease in pump speed; this case does not separate their effects.
03The patient's lung function failed to improve and she expired despite prolonged ECMO support.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only the described patient is reported, so it cannot show that circuit chugging causes excess fluid administration in all ARDS patients. There is no comparison group, so the case cannot show that albumin, lower pump speed, or the proposed algorithm improved survival or lung function. The authors state that there is no data to guide optimal management of chugging. The management algorithm is expert suggestion and was not tested in patients. The patient died despite prolonged ECMO support.
Declared interests
The supplied publication types include NIH extramural and non-U.S. government research support; the supplied text does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not conclude that repeated albumin boluses or the suggested algorithm improve outcomes in ARDS patients on veno-venous ECMO. This is a single case, the authors state there is no data to guide optimal management, and the patient died despite prolonged ECMO support.