Mechanical ventilation management during ECMO for ARDS: an international multicenter prospective cohort

Matthieu Schmidt, Tài Pham, Antonio Arcadipane, Cara Agerstrand, Shinichiro Ohshimo, Vincent Pellegrino, Alain Vuylsteke, Christophe Guervilly, Shay McGuinness, Sophie Pierard, Jeff Breeding, Claire Stewart, Simon Sin Wai Ching, Janice M. Camuso, R. Scott Stephens, Bobby King, Daniel Herr, Marcus J. Schultz, Mathilde Neuville, Elie ZogheibJean-Paul Mira, Hadrien Rozé, Marc Pierrot, Anthony Tobin, Carol L. Hodgson, Sylvie Chevret, Daniel Brodie, Alain Combes, for the International ECMO Network (ECMONet), and the LIFEGARDS Study Group

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OBJECTIVES: To report current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) and their association with 6-month outcomes. METHODS: International, multi-center, prospective cohort study of patients undergoing ECMO for ARDS during a one-year period in 23 international intensive care units (ICUs). MEASUREMENTS AND MAIN RESULTS: We collected demographics, daily pre- and per-ECMO mechanical ventilation settings and use of adjunctive therapies, ICU- and 6-month-outcome data for 350 patients (median ± standard deviation pre-ECMO PaO2/FiO2 71±34 mmHg). Pre-ECMO use of prone positioning and neuromuscular blockers were 26% and 62%, respectively. Tidal volume (6.4±2.0 vs 3.7±2.0 ml/kg), plateau pressure (32±7 vs 24±7cmH2O), driving pressure (20±7 vs. 14±4 cmH2O), respiratory rate (26±8 vs 14±6 breaths/min) and mechanical power (26.1±12.7 vs. 6.6±4.8 J/min) were markedly reduced after ECMO initiation. Six-month survival was 61%. No association was found between ventilator settings during the first 2 days of ECMO and survival in multivariable analysis. A time-varying Cox model retained older age, higher fluid balance, higher lactate, and more need for renal replacement therapy along the ECMO course as being independently associated with 6-month mortality. A higher tidal volume and lower driving pressure (likely markers of static compliance improvement) across the ECMO course were also associated with better outcomes. CONCLUSION: Ultra-protective lung ventilation on ECMO was largely adopted across medium to high case-volume ECMO centers. In contrast with previous observations, mechanical ventilation settings during ECMO did not impact patients' prognosis in this context.
Original languageEnglish
Pages (from-to) 1002-1012
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number8
Publication statusPublished - 15 Oct 2019

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