Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Aust Crit Care. 2023 Sep;36(5):828-831. doi: 10.1016/j.aucc.2022.11.009. Epub 2023 Jan 4.
The use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure and during cardiopulmonary resuscitation has increased significantly and is resource intensive. High-quality evidence to guide management of patients on ECMO is limited.
The objective of this study was to determine the research priorities of clinicians for ECMO and Extracorporeal Membrane Oxygenation Cardiopulmonary Resusciation (ECPR) in Australia and New Zealand.
A prospective, binational survey of clinicians was conducted in May 2022.
There were 133 respondents; 110 (84%) worked at an Australian ECMO centre; 28 (21%) were emergency, 45 (34%) were intensive care, and 41 (31%) were nursing clinicians. All aspects of ECMO care were identified by respondents as being important for further research; however, appropriate patient selection and determining long-term outcomes were ranked the highest. While most believed ECMO was efficacious, they felt that there was insufficient evidence to determine cost-effectiveness. There was uncertainty of the best model of ECPR provision. Equipoise exists for randomised studies into anticoagulation, blood product usage, and ECPR.
This survey found strong support amongst clinicians for further research into the optimal use of ECMO and ECPR and provides a frame work for prioritising future clinical trials and research agendas.
体外膜肺氧合（ECMO）在心肺衰竭和心肺复苏期间的应用显著增加，且资源密集。指导 ECMO 患者管理的高质量证据有限。
本研究旨在确定澳大利亚和新西兰临床医生对 ECMO 和体外膜肺氧合心肺复苏（ECPR）的研究重点。
2022 年 5 月，对临床医生进行了一项前瞻性、两国性的调查。
共有 133 名受访者，其中 110 名（84%）在澳大利亚 ECMO 中心工作；28 名（21%）为急诊医生，45 名（34%）为重症监护医生，41 名（31%）为护理临床医生。受访者认为 ECMO 护理的各个方面都需要进一步研究，但适当的患者选择和确定长期结果被认为是最重要的。虽然大多数人认为 ECMO 有效，但他们认为没有足够的证据来确定其成本效益。ECPR 的最佳提供模式也存在不确定性。对于抗凝、血液制品使用和 ECPR 的随机研究存在争议。
这项调查发现，临床医生强烈支持进一步研究 ECMO 和 ECPR 的最佳使用，并为未来临床试验和研究议程提供了优先框架。
