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Mechanical ventilation during extracorporeal membrane oxygenation. An international survey.
Ann Am Thorac Soc. 2014 Jul; 11(6):956-61.AA

Abstract

RATIONALE

In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear.

OBJECTIVES

Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO).

METHODS

We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis.

MEASUREMENTS AND MAIN RESULTS

We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation.

CONCLUSIONS

Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation.

Authors+Show Affiliations

Interdepartmental Division of Critical Care Medicine, and Department of Medicine, University of Toronto, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

24983618

Citation

Marhong, Jonathan D., et al. "Mechanical Ventilation During Extracorporeal Membrane Oxygenation. an International Survey." Annals of the American Thoracic Society, vol. 11, no. 6, 2014, pp. 956-61.
Marhong JD, Telesnicki T, Munshi L, et al. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc. 2014;11(6):956-61.
Marhong, J. D., Telesnicki, T., Munshi, L., Del Sorbo, L., Detsky, M., & Fan, E. (2014). Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Annals of the American Thoracic Society, 11(6), 956-61. https://doi.org/10.1513/AnnalsATS.201403-100BC
Marhong JD, et al. Mechanical Ventilation During Extracorporeal Membrane Oxygenation. an International Survey. Ann Am Thorac Soc. 2014;11(6):956-61. PubMed PMID: 24983618.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. AU - Marhong,Jonathan D, AU - Telesnicki,Teagan, AU - Munshi,Laveena, AU - Del Sorbo,Lorenzo, AU - Detsky,Michael, AU - Fan,Eddy, PY - 2014/7/2/entrez PY - 2014/7/2/pubmed PY - 2015/4/15/medline KW - Extracorporeal Life Support Organization KW - acute respiratory distress syndrome KW - extracorporeal membrane oxygenation KW - international survey KW - mechanical ventilation SP - 956 EP - 61 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 11 IS - 6 N2 - RATIONALE: In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear. OBJECTIVES: Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO). METHODS: We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis. MEASUREMENTS AND MAIN RESULTS: We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation. CONCLUSIONS: Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation. SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/24983618/Mechanical_ventilation_during_extracorporeal_membrane_oxygenation__An_international_survey_ L2 - https://www.atsjournals.org/doi/10.1513/AnnalsATS.201403-100BC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -