Introduction: Pulmonary hypertension (PH) is a multifactorial disorder characterized by elevated pulmonary artery pressures, leading to right ventricular dysfunction and heart failure. If unrecognized, it can result in progressive dyspnea, right heart failure, and even death. Identifying the underlying causes of pulmonary hypertension is essential, as it can significantly impact the treatment approach. This case report presents a rare occurrence of Group 1 pulmonary hypertension caused by anomalous pulmonary venous return in an elderly male, a condition that remained undetected until later in life. Case Presentation: A 79-year-old male with a 40-year smoking history and chronic obstructive pulmonary disease (COPD) presented to the pulmonary clinic with progressive shortness of breath and fatigue over several months. He denied experiencing chest pain, syncope, or presyncope, but reported worsening lower extremity edema. He had previously been diagnosed with emphysema by his primary care physician and had been treated with inhalers, which provided limited relief. On examination, the patient's vital signs were stable, and he required continuous oxygen supplementation. An echocardiogram showed mild to moderate right ventricular dilation, with a right ventricular systolic pressure of 55 mmHg and an ejection fraction of 50-60%. Initially, there was a suspicion of Group III pulmonary hypertension, given the presence of emphysema. A CT pulmonary angiogram was performed, which revealed partial anomalous pulmonary venous return, with one pulmonary vein draining into the superior vena cava. This anatomical anomaly had contributed to the development of pulmonary hypertension. Given the patient's advanced age, surgical intervention was deemed unsuitable, and he was managed with diuretics and oxygen therapy. Discussion: Anomalous pulmonary venous return is a rare congenital defect that can lead to pulmonary hypertension due to increased pulmonary blood flow and pressure. In this case, the patient's symptoms were initially attributed to his smoking history and emphysema, delaying the diagnosis of the anomalous venous return until later in life. This case underscores the importance of a multidisciplinary approach in managing pulmonary arterial hypertension and highlights the need for heightened awareness of rare congenital conditions that can influence the diagnosis and management of pulmonary hypertension in similar patients.

Introduction: Sudden cardiac arrest affects over 600,000 people in the USA. Timely and effective cardiopulmonary resuscitation (CPR) is very important for the return of spontaneous circulation (ROSC). Iatrogenic complication of CPR should also be considered in post arrest care. More data is needed to increase awareness of post CPR complications. Here we report a case of a rare finding of liver laceration post CPR which resulted in hemorrhagic shock. Description: A 51-year-old woman was brought to the emergency department for evaluation following a witnessed syncopal episode at home. She had cardiac arrest in the field, ROSC was achieved after 3 minutes of CPR. On arrival, she was hypoxic, hypotensive and tachycardic (sinus rhythm). Shortly after intubation, she coded again requiring CPR. CT scan of the chest showed sub massive PE in bilateral lower lobes. She underwent emergent mechanical thrombectomy, placed on heparin infusion, and was admitted to the ICU. She was on multiple pressors. Bedside echo showed no significant right ventricular dysfunction to explain persistent hypotension. Abdominal ultrasound revealed a large amount of free fluid in her abdomen which prompted immediate discontinuation of heparin and reversal with protamine. Massive blood transfusion protocol was initiated. Urgent CTA confirmed massive intra-abdominal hemorrhage. Closer review of imaging obtained during the initial CT study demonstrated mild active abdominal bleeding. An unintended consequence of CPR, liver laceration caused bleeding which was further exacerbated by anticoagulation with heparin infusion. Once heparin was discontinued and reversed, serial imaging confirmed no further bleeding from the laceration. She appropriately responded to resuscitation and successfully weaned off all pressors. Shortly after being transferred out of the ICU, she was able to be safely discharged home. Discussion: CPR-induced complications such as visceral or arterial laceration can be lethal. In the event of unexpected post-resuscitation shock, the differential must include hemoperitoneum or hemothorax, especially in the setting of active anticoagulation. Effective utilization of serial bedside ultrasound exam allows for immediate evaluation and earlier opportunity for life-saving intervention.

Unilateral absence of pulmonary artery (UAPA) is a congenital clinical abnormality that is rarely diagnosed in adulthood. Due to its rarity and heterogeneity as it pertains to its clinical presentation, it may be difficult to diagnose, often leading to misdiagnosis. We present a case of UAPA with unilateral pulmonary fibrosis which was misdiagnosed as rheumatoid arthritis-associated interstitial lung disease (RA-ILD). We describe the symptomology, physical examination findings, laboratory values and radiologic findings. We also describe the diagnostic challenges and approach to a patient presenting with unilateral interstitial lung disease (ILD) and highlight the importance of a comprehensive evaluation.

OBJECTIVE:Total artificial heart (TAH) utilization has increased over the recent years. The goal of this study was to evaluate the trend of artificial hearts used in the USA with its associated morbidity and mortality based on a large in-hospital database.MATERIALS AND METHODS:Using a very large nationwide inpatient samples (NIS) database, we used ICD-9 code for a total artificial heart. We evaluated the utilization of this device over the years studied. Furthermore, we evaluated any associated complications and mortality in patients receiving this device.RESULTS:From 2004 until 2011, the rate of total artificial heart implants increased over the years from 5 in 2004 to the highest of 26 in 2011 across the United State. TAH was insesrted in 75 patients. Death was reported in 22 patients (29.3%). Acute renal failure was the most common complication (69.3%). This is followed by post-operative infectious complications (28.0%), acute renal failure requiring dialysis (16%), bleeding complications requiring blood transfusion (14.7%) respiratory complications (6.7%), and stroke/TIA (4.0%). There was no post-operative deep vein thrmobosis or pulmonary embolism.CONCLUSIONS:The use of total artificial heart has increased in the United State steadily with substantial morbidity and mortality associated with this device.

TOPIC: Occupational and Environmental Lung Diseases TYPE: Fellow Case Reports INTRODUCTION: Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a highly variable syndrome that is thought to result from hypersensitivity to inhaled environmental antigens, although the immunopathogenesis is not well understood. Given the high degree of variability in clinical presentations and hundreds of reported etiologies, making a diagnosis of HP requires a thorough exposure history and high degree of clinical suspicion. Adequate literature on the various causes of HP is lacking. Here we present a case of hypersensitivity pneumonitis secondary to home ultrasonic humidifier. CASE PRESENTATION: A 23-year-old never-smoker seven months post-partum and actively breast feeding female presented with a cough and progressive shortness of breath for past ten days. Her symptoms had persisted despite outpatient antibiotics. Her initial exam in ED was notable for severe hypoxemic respiratory failure requiring high flow nasal oxygen. She was placed on BIPAP and admitted to ICU for further care. Her CT scan of the chest showed diffuse bilateral ground glass opacities. An extensive infectious work-up was negative. Bronchoscopy was not performed due to tenuous respiratory status. She had significantly elevated inflammatory markers with no clear autoimmune process. Her exposure history was notable for use of a new ultrasonic humidifier which she had purchased after her child was born. She was started on steroids for presumed acute HP with significant improvement in her symptoms. An HP panel returned positive for antibodies to Thermoactinomyces vulgaris, which has been found to colonize humidifiers and has been associated with HP. The patient was discharged on a steroid taper. She removed the humidifier from her home. Eight weeks later, on her outpatient clinic follow-up, she had significant improvement in symptoms and repeat CT chest had shown clearance of infiltrates. DISCUSSION: Diagnosis of HP is difficult to make. Pulmonary function tests and CT scan of the lungs can be nonspecific to help with diagnosis. Symptoms from HP can be severe and disabling, particularly if the offending antigen is not identified and removed from the environment. Instances of HP from Thermoactinomyces from home humidifiers are very rare but with increasing popularity of ultrasonic humidifiers there may be many cases which may be undiagnosed. CONCLUSIONS: Our case report provides literary evidence for humidifiers as a potential antigen source. This can guide clinicians in obtaining a thorough exposure history and make an appropriate diagnosis. REFERENCE #1: Spagnolo P, Rossi G, Cavazza A, Bonifazi M, Paladini I, Bonella F, Sverzellati N, Costabel U. Hypersensitivity Pneumonitis: A Comprehensive Review. J Investig Allergol Clin Immunol. 2015;25(4):237-50; quiz follow 250. PMID: 26310038. REFERENCE #2: Shimoda M, Morimoto K, Tanaka Y, Ken O, Yoshimori K. Humidifier lung induced by endotoxin and various pathogens: Characteristic differences from other phenotypes of hypersensitivity pneumonitis. Respir Med Case Rep. 2020;31:101267. Published 2020 Oct 20. doi:10.1016/j.rmcr.2020.101267 REFERENCE #3: Burge HA, Solomon WR, Boise JR. Microbial prevalence in domestic humidifiers. Appl Environ Microbiol. 1980 Apr;39(4):840-4. doi: 10.1128/AEM.39.4.840-844.1980. PMID: 7377779; PMCID: PMC291430. DISCLOSURES: No relevant relationships by Katie Capp, source=Web Response No relevant relationships by Hem Desai, source=Web Response

Rationale: There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared with lobectomy performed by thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared with open surgical lobectomy. Objectives: We used data from the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2009 to 2012 to compare VATS with open lobectomy for in-hospital mortality and other short-term outcomes. Methods: We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify the patients undergoing lobectomy. We used 1: 1 ratio propensity matching with the nearest neighbor method without replacement to generate matched pairs. Measurements and Main Results: Over the 4-year period, 27,451 patients underwent lobectomy. The majority of these procedures were performed by thoracotomy (65%) as compared with VATS (35%). A total of 9,393 matched pairs were created. VATS lobectomy was associated with significantly lower in-hospital mortality when compared with thoracotomy (1.3% vs. 2.5%, P < 0.001). A shorter length of hospital stay was observed for those undergoing VATS lobectomy (6.21 vs. 8.75 d, P < 0.001). The overall rate of perioperative complications was low, with those undergoing VATS being less likely to have any perioperative morbidity. Conclusions: In recent years, the use of VATS for lobectomy has increased relative to thoracotomy. This trend has coincided with increased survival and shorter length of stay for VATS lobectomy compared with thoracotomy. Further studies are needed to identify comorbidities that identify ideal candidates for VATS lobectomy.

BACKGROUND: Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.METHODS: We did a retrospective analysis using multi-institutional observational data from the Nationwide Inpatient Sample database. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were used to identify the patients with pulmonary embolism and right ventricular dysfunction. In-hospital mortality was defined as the primary outcome of interest.RESULTS: Over the 4 years of the study period, 3668 patients with right ventricular dysfunction and pulmonary embolism were found, of which 3253 patients were identified as having hemodynamically stable right-sided heart failure with pulmonary embolism. There was no significant difference in mortality between hemodynamically stable pulmonary embolism patients with right ventricular dysfunction who received thrombolytic agents compared with those who did not. When outcomes were assessed for patients with right ventricular dysfunction and hemodynamic instability, a significant improvement in mortality was noted for patients with right ventricular dysfunction who received thrombolytic agents, which confirmed previous reports that thrombolytic therapy decreases mortality in pulmonary embolism patients who are hemodynamically unstable.CONCLUSION: Our data support the use of less aggressive treatment for stable pulmonary embolism patients with right ventricular dysfunction. These results argue against the reflexive use of thrombolytic agents in stable pulmonary embolism patients with right ventricular dysfunction. (C) 2016 Elsevier Inc. All rights reserved.

2016;44:1515–1522. 3 Cochi SE, Kempker JA, Annangi S, Kramer MR, Martin GS. Mortality trends of acute respiratory distress syndrome in the United States from 1999 to 2013. Ann Am Thorac Soc 2016;13:1742–1751. 4 Soto GJ, Martin GS, Gong MN. Healthcare disparities in critical illness. Crit Care Med 2013;41:2784–2793. 5 Garcia JG, Sznajder JI. Healthcare disparities in patients with acute respiratory distress syndrome: toward equity. Am J Respir Crit Care Med 2013;188:631–632.

RATIONALERacial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure.OBJECTIVESUsing a large, representative, U.S. nationwide database, we examined the hypothesis that black and Hispanic patients with severe acute respiratory failure have higher mortality rates when compared with non-Hispanic whites.METHODSThis retrospective analysis used discharge data from the Agency for Healthcare Research and Quality, Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, for the years 2008-2012. We identified hospitalizations with acute respiratory failure using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification, codes. A logistic regression model was fitted to compare in-hospital mortality rates by race.MEASUREMENTS AND MAIN RESULTSAfter adjusting for sex, age, race, disease severity, type of hospital, and median household income for patient ZIP code, blacks had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < 0.001), and Hispanics also had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (OR, 1.17; 95% CI, 1.15-1.19; P < 0.001), and so did Asian and Pacific Islanders (OR, 1.15; 95% CI, 1.12-1.18; P < 0.001) and Native Americans (OR, 1.08; 95% CI, 1.00-1.15; P < 0.001) when compared with non-Hispanic whites (OR, 1.0).CONCLUSIONSBlacks, Hispanics, and other racial minorities in the United States were observed to exhibit significantly higher in-hospital sepsis-related respiratory failure associated mortality when compared with non-Hispanic whites.

INTRODUCTION:Recent advances in technology and protocols have made the use of extracorporeal membrane oxygenation (ECMO) a viable rescue therapy for patients with ARDS who present with refractory hypoxemia. Despite the lack of strong evidence supporting the use of ECMO in ARDS, its use seems to be increasing. We sought to determine recent trends in the use of ECMO for ARDS. We also assessed trends in mortality among patients with ARDS in whom ECMO was used.METHODS:We performed a retrospective analysis using the largest all-payer in-patient healthcare database in the United States, the Healthcare Cost and Utilization project, the National In-patient Sample database from 2008 to 2012. Subjects with ARDS were identified using carefully chosen International Classification of Diseases, Ninth Revision codes.RESULTS:We found that in 2008, about 1 in 1,000 subjects with ARDS underwent ECMO. Over the subsequent 4-y time period, there was a 0.19% absolute increase and 70% relative increase in the use of ECMO for ARDS. The mortality rate among subjects with ARDS in whom ECMO was used declined from 78% in 2008 to 64% in 2012. We also found a trend toward a reduction in hospital stay among survivors.CONCLUSION:In the United States, between 2008 and 2012, there was an increasing trend toward the use of ECMO in patients with ARDS that coincided with a slight increase in survival among these patients.

Fungal endocarditis is an extremely debilitating disease associated with high morbidity and mortality. Candida spp. are the most common isolated organisms in fungal endocarditis. It is most prevalent in patients who are immunosuppressed and intravenous drug users. Most patients present with constitutional symptoms, which are indistinguishable from bacterial endocarditis, hence a high index of suspicion is required for pursuing diagnosis. Diagnosis of fungal endocarditis can be very challenging: most of the time, blood cultures are negative or take a long time to yield growth. Fungal endocarditis mandates an aggressive treatment strategy. A medical and surgical combined approach is the cornerstone of therapy.

To cite: Fotouhie A, Desai H, King S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016214437 SUMMARY There is a well-known association between vitamin K deficiency and haemorrhagic events including gastrointestinal bleeding. There is also a well-known association between both poor dietary intake of vitamin K and chronic antibiotic use and the development of vitamin K deficiency. Although the medical literature notes that cephalosporin antibiotics have a propensity to cause vitamin K deficiency due to the molecular structure of the medications and their ability to suppress the synthesis of clotting factors, there are other antibiotics that have also been implicated in the development of vitamin K deficiency. There are very few reports of trimethoprim/sulfamethoxazole causing vitamin K deficiency and further leading to bleeding episodes. We present such a case and discuss the risk factors leading to such complications.

A patient's persistent hypoxia guided the diagnosis away from acute coronary syndrome toward the true cause of his signs and symptoms. Paramedics brought an 85-year-old African American man to the emergency department after he became dizzy in a supermarket. He felt that his legs were giving way, and a fall was imminent. However, he did not fall or lose consciousness. Until this event, he had been in his usual state of health.

SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Data regarding outcomes of patients with pulmonary hypertension (PH) undergoing elective non-cardiac surgery is limited to single institution experiences. We used the National Inpatient Sample(NIS)-Healthcare Cost and Utilization Project (HCUP) database from years 2009 till 2012 to compare the in hospital mortality and mean length of stay of patients with pulmonary hypertension as comorbidity against patients with no known pulmonary hypertension undergoing total knee arthroplasty and total hip arthroplasty- both elective, non cardiac and non-thoracic surgeries. METHODS: This was a retrospective analysis of the HCUP-NIS database for the years 2009 to 2012. We identified patients undergoing THA and TKA using the following International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes: 81.51 and 81.54 respectively. Pulmonary hypertension as comorbidity was identified using ICD-9-CM codes 416.0, 416.8 and 416.9. The outcomes were: in hospital mortality, hospital length of stay and perioperative respiratory complications. We generated a propensity score using the next neighbor method without replacement with 1:1 matching. We then compared the outcomes. RESULTS: A total of 3,770,511 cases of THA and TKA were identified. 4,939 matched pairs of patients with and without pulmonary hypertension that underwent the surgeries were identified. Length of stay in propensity matched cohort was 4.7 days in PH group vs 3.8 days in the no PH group. Odds of death were 4.4 for PH compared to no PH (p <0.0005). Odds of respiratory complications were 3.26 in PH compared to no PH (p <0.0005). No significant difference in the odds of bleeding and vascular complications were noted between the two groups. CONCLUSIONS: Patients with pulmonary hypertension who undergo elective knee or hip arthroplasty are at increased risk for perioperative morbidity and mortality. CLINICAL IMPLICATIONS: Risk stratification of the presurgical patients based on their pulmonary hypertension comorbidity should be an important part of their preoperative workup. DISCLOSURE: The following authors have nothing to disclose: Hem Desai, Bhupinder Natt, Christian Bime No Product/Research Disclosure Information

There is a well-known association between vitamin K deficiency and haemorrhagic events including gastrointestinal bleeding. There is also a well-known association between both poor dietary intake of vitamin K and chronic antibiotic use and the development of vitamin K deficiency. Although the medical literature notes that cephalosporin antibiotics have a propensity to cause vitamin K deficiency due to the molecular structure of the medications and their ability to suppress the synthesis of clotting factors, there are other antibiotics that have also been implicated in the development of vitamin K deficiency. There are very few reports of trimethoprim/sulfamethoxazole causing vitamin K deficiency and further leading to bleeding episodes. We present such a case and discuss the risk factors leading to such complications.

CONTEXT:Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (β)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding.CASE REPORT:A 76-year-old gentleman with a history of bilateral arthroplasty was admitted with a swollen left knee. Blood cultures were positive for Enterococcus faecium. Left knee joint aspiration showed leukocytosis and alpha defensins. Extensive imaging did not show any other source of infection. Culture sensitivity results showed multidrug-resistant enterococci sensitive to daptomycin. The patient was started on intravenous (IV) daptomycin. His left knee prosthesis was explanted and a spacer was placed. The patient continued to be bacteremic for 10 days after removing the knee prosthesis. The patient was trialed on combination IV ampicillin and daptomycin. His blood culture turned negative 2 days later. The patient was discharged home to continue 6 weeks of IV ampicillin and daptomycin.CONCLUSION:The exact mechanism of the daptomycin/ampicillin synergy effect is unclear. Current hypothesis suggests that ampicillin causes a reduction in the net positive charge of the bacterial surface, possibly by releasing lipoteichoic acid (LTA) from the cell wall. This process increases the ability of the cationic daptomycin/calcium complex to bind to the cell wall more effectively. Our case shows the clinical application of the same. A prospective randomized control trial to explore the effectiveness of dual antibiotic therapy in vivo is needed. If proven, daptomycin/β-lactam can become a standard of care to treat VRE and decrease daptomycin nonsusceptibility.

SESSION TITLE: ARDS Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: To study the trends of ARDS related hospital discharges and associated mortality rates in the United States. METHODS: We performed retrospective analysis using Healthcare Cost and Utilization project-National Inpatient Sample (HCUP-NIS) hospital discharge data from the year 2008 to 2012. Sample selection was based on International Classification of Diseases, Ninth Revision (ICD-9) codes. We captured the ARDS patients and subset of ARDS patients with severe sepsis and septic shock (ARDS-Sepsis group) using following codes: 518.82, 518.51, 518.52, 518.53, 518.81, 518.84, 518.7, 518.4, 861.20, 785.52, 995.92 and procedures codes: 96.70, 96.71, and 96.72. We studied yearly data of ARDS related hospital discharges and mortality trends from years 2008 till 2012. All the reported analyses are national estimates calculated using the survey weights. RESULTS: There was an increasing trend of ARDS related hospital discharges as follows: 1.48% in 2008, 1.56% in 2009, 1.69% in 2010, 1.82% in 2011 and 2.03% in 2012. Discharges for ARDS associated with sepsis or septic shock followed a similar trend; 0.39% in 2008, 0.43% in 2009. 0.47% in 2010, 0.52% in 2011 and 0.55% in 2012. There was a decreasing trend in ARDS associated mortality; 33.82% in 2008, 33.01% in 2009, 31.32% in 2010, 30.94% in 2011 and 29.4% in 2012. Mortality from ARDS associated with sepsis also had a similar decreasing trend over these 5 years; 51.21% in 2008, 49.01% in 2009, 47.28% in 2010, 45.72% in 2011 and 44.69% in 2012. CONCLUSIONS: From 2008 to 2012, there was an increasing trend of ARDS related hospital discharges in the United States. There was also a decreasing trend of ARDS associated mortality during the same period. CLINICAL IMPLICATIONS: Even though the reasons remain unclear and probably multifactorial, mortality rates in ARDS seem to have consistently improved from 2008 till 2012. DISCLOSURE: The following authors have nothing to disclose: Bhupinder Natt, Hem Desai, Nimal Singh, Chithra Poongkunran, Christian Bime No Product/Research Disclosure Information

SESSION TITLE: ECMO Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: We studied national trends in Extracorporeal Membrane Oxygenator (ECMO) use for ARDS in the USA from 2008 to 2012. METHODS: We performed retrospective analysis using Healthcare Cost and Utilization project-National Inpatient Sample (HCUP-NIS) hospital discharge data from 2008 to 2012. ICD-9 codes and CPT codes were used to identify patients with who were placed on ECMO for ARDS. We captured ARDS patients using the following codes: 518.82, 518.51, 518.52, 518.53, 518.81, 518.84, 518.7, 518.4, 861.20, 785.52, 995.92 and procedures codes: 96.70, 96.71, and 96.72. RESULTS: Trend results over time show increasing use of ECMO in ARDS treatment. 135 of 158076 ARDS patients (0.08%) were treated with ECMO in 2008. The following years this number seems to have increased; 365 of 171473 (0.21%) in 2009, 270 of 183073 (0.14%) in 2010, 399 of 201195 (0.19%) in 2011 and 535 of 201095 (0.26%) in 2012. The hospital length of stay for ARDS patients treated with ECMO decreased from 39 days in 2008 to 28.5 days in 2012. Age, gender, race and socio-economic differences in ECMO use for ARDS are also being assessed and will be presented. CONCLUSIONS: From 2008 onwards, there has been an increase in the use of ECMO as rescue therapy for ARDS in the United States. CLINICAL IMPLICATIONS: As ECMO use in ARDS becomes prevalent, more familiarity and training of Critical Care Physicians and trainees will be required. DISCLOSURE: The following authors have nothing to disclose: Bhupinder Natt, Hem Desai, Chithra Poongkunran, Christian Bime, Nimal Singh, Yuval Raz No Product/Research Disclosure Information