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Semin Respir Crit Care Med 2022; 43(03): 417-425
DOI: 10.1055/s-0042-1749450
Review Article

Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects

Gabriele Fior
1   Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
2   Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
,
Zasha F. Vazquez Colon
3   Department of Pediatrics, Division of Pediatric Critical Care, University of Florida, Shands Children's Hospital, Gainesville, Florida
,
Giles J. Peek
4   Department of Surgery, Congenital Heart Center, Shands Children's Hospital, Gainesville, University of Florida, Gainesville, Florida
,
John F. Fraser
1   Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
2   Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
5   Intensive Care Unit, St Andrew's War Memorial Hospital and The Wesley Hospital, Uniting Care Hospitals, Brisbane, QLD, Australia
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Abstract

Acute Respiratory Distress Syndrome (ARDS) accounts for 10% of ICU admissions and affects 3 million patients each year. Despite decades of research, it is still associated with one of the highest mortality rates in the critically ill. Advances in supportive care, innovations in technologies and insights from recent clinical trials have contributed to improved outcomes and a renewed interest in the scope and use of Extracorporeal life support (ECLS) as a treatment for severe ARDS, including high flow veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) and low flow Extracorporeal Carbon Dioxide Removal (ECCO2R). The rationale being that extracorporeal gas exchange allows the use of lung protective ventilator settings, thereby minimizing ventilator-induced lung injury (VILI). Ventilation strategies are adapted to the patient's condition during the different stages of ECMO support. Several areas in the management of mechanical ventilation in patients on ECMO, such as the best ventilator mode, extubation-decannulation sequence and tracheostomy timing, are tailored to the patients' recovery. Reduction in sedation allowing mobilization, nutrition and early rehabilitation are subsequent therapeutic goals after lung rest has been achieved.

Keywords

extracorporeal membrane oxygenation - extracorporeal life support - acute respiratory distress syndrome - ventilator-induced lung injury - ultra-protective lung ventilation - mechanical ventilation - mechanical ventilation strategies


Publication History

Article published online:
27 June 2022

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