Publications

BACKGROUND

The use of venovenous extra corporeal membrane oxygenation (VV ECMO) for acute respiratory failure (ARF)/acute respiratory (ARDS) has increased since 2009. Specialized units for patients requiring VV ECMO are not standard and patients are often cohorted with other critically ill patients. The purpose of this study was to report the outcome of adult patients admitted in 2015 to the lung rescue unit, which, to our knowledge, is the first intensive care unit in the United States that has been specifically created to provide care for patients requiring VV ECMO.

METHODS

Data were collected on all patients admitted to the lung rescue unit on VV ECMO between January 1, 2015, and December 31, 2015. Demographics, medical history, pre-ECMO data, indication for VV ECMO as well as duration of ECMO and survival to decannulation and discharge were recorded. Means (± standard deviation) and medians (interquartile range [IQR]) were reported when appropriate.

RESULTS

Forty-nine patients were enrolled. Median age was 48 years (IQR, 32-57). Median PaO2/FIO2 ratio before cannulation was 66 (IQR, 53-86). Median ventilator days before cannulation was 2 (IQR, 1-4). Median time on VV ECMO for all patients was 311 hours (IQR, 203-461). Thirty-eight (78%) patients were successfully decannulated with 35 (71%) patients surviving to hospital discharge.

CONCLUSION

The use of VV ECMO for ARF/ARDS is increasing. We have demonstrated that a dedicated multidisciplinary intensive care unit for the purpose of providing standardized care with specialized trained providers can improve survival to discharge for patients that require VV ECMO for ARF/ARDS.

LEVEL OF EVIDENCE

Therapeutic, level V.

This year's Founders' Lecture will focus on the founding and history of the Association for Academic Surgery (AAS), as presented by five past presidents. The lecture will give the readers a unique and condensed perspective on the remarkable history of the AAS. The AAS was founded in 1967 by Dr George Zuidema with the mission to offer young academic surgeons an inclusive forum for discussion about surgical research and the opportunity for professional growth.1 Since its establishment in 1966, with a membership of only 33 people,1the organization has grown into a diverse international organization with over 2800 members. Today, the AAS embraces five core values to promote the careers of young academic surgeons: inclusion, leadership, innovation, scholarship, and mentorship. In this introduction to the brief history of the AAS, we review how this organization emerged from these principles.

Patient reported outcomes (PROs) are reports of health conditions that come directly from patients. Use of PROs has been associated with improved patient outcomes, enhanced quality of life, and reduced end-of-life spending. Yet there are still outstanding questions regarding the process of implementing PRO collection in routine practice. In this article, we describe the experience of selecting and implementing PROs in a multisite, multidisease academic medical center-based radiation oncology practice and demonstrate that such large-scale rollout is feasible. We establish that PROs can be implemented with minimal to no workflow delays, are generally seen as valuable by clinicians, and can enhance patient-doctor communication. We additionally detail the challenges involved in selecting clinically relevant PRO questionnaires and the centrality of physician buy-in, easy data access, and clear workflows to successful implementation.