Skip to main content
SpringerLink
Log in

Ventilation During Veno-Venous Extracorporeal Membrane Oxygenation

  • Chapter
  • First Online:
Cardiopulmonary Monitoring

  • 3134 Accesses

Abstract

The target of extracorporeal membrane oxygenation (ECMO) support is to grant adequate gas exchange, while decreasing mechanical ventilation load on the natural lung and minimizing ventilator-induced lung injury in all of its aspects. However, mechanical ventilation is still necessary during veno-venous ECMO, in order to prevent lung atelectasis and/or in case of extracorporeal blood flows not sufficient to guarantee adequate gas exchange. In this chapter, we will first focus on the physiology of extracorporeal support. Then we will review the current mechanical ventilation settings adopted during extracorporeal support among ECMO, the rationale behind different approaches, and the potential use of ECMO to allow ultra-protective mechanical ventilation. Finally, the use of assisted or spontaneous ventilation will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195:438–42.

    Article  PubMed  Google Scholar 

  • Camporota L, Nicoletti E, Malafronte M, De Neef M, Mongelli V, Calderazzo MA, Caricola E, Glover G, Meadows C, Langrish C, Ioannou N, Wyncoll D, Beale R, Shankar-Hari M, Barrett N. International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure. Minerva Anestesiol. 2015;81:1170–83, 77 p following 1183.

    CAS  PubMed  Google Scholar 

  • Combes A, Brodie D, Bartlett R, Brochard L, Brower R, Conrad S, De Backer D, Fan E, Ferguson N, Fortenberry J, Fraser J, Gattinoni L, Lynch W, MacLaren G, Mercat A, Mueller T, Ogino M, Peek G, Pellegrino V, Pesenti A, Ranieri M, Slutsky A, Vuylsteke A, International ECMO Network (ECMONet). Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190:488–96.

    Article  PubMed  Google Scholar 

  • Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A, EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–75.

    Article  PubMed  Google Scholar 

  • Crotti S, Bottino N, Ruggeri GM, Spinelli E, Tubiolo D, Lissoni A, Protti A, Gattinoni L. Spontaneous breathing during extracorporeal membrane oxygenation in acute respiratory failure. Anesthesiology. 2017;126:678–87.

    Article  PubMed  Google Scholar 

  • Crotti S, Bottino N, Spinelli E. Spontaneous breathing during veno-venous extracorporeal membrane oxygenation. J Thorac Dis. 2018;10:S661–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Doorduin J, Nollet JL, Roesthuis LH, van Hees HWH, Brochard LJ, Sinderby CA, van der Hoeven JG, Heunks LMA. Partial neuromuscular blockade during partial ventilatory support in sedated patients with high tidal volumes. Am J Respir Crit Care Med. 2017;195:1033–42.

    Article  PubMed  Google Scholar 

  • Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287:345–55.

    Article  PubMed  Google Scholar 

  • Extracorporeal Life Support Organization. Extracorporeal Life Support Organization (ELSO) guidelines for adult respiratory failure. 2017. https://www.elso.org/Portals/0/ELSO%20Guidelines%20For%20Adult%20Respiratory%20Failure%201_4.pdf.

  • Franchineau G, Bréchot N, Lebreton G, Hekimian G, Nieszkowska A, Trouillet J-L, Leprince P, Chastre J, Luyt C-E, Combes A, Schmidt M. Bedside contribution of electrical impedance tomography to setting positive end-expiratory pressure for extracorporeal membrane oxygenation-treated patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;196:447–57.

    Article  CAS  PubMed  Google Scholar 

  • Gattinoni L, Pesenti A. The concept of “baby lung”. Intensive Care Med. 2005;31:776–84.

    Article  PubMed  Google Scholar 

  • Gattinoni L, Kolobow T, Agostoni A, Damia G, Pelizzola A, Rossi GP, Langer M, Solca M, Citterio R, Pesenti A, Fox U, Uziel L. Clinical application of low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCO2R) in treatment of adult respiratory distress syndrome (ARDS). Int J Artif Organs. 1979;2:282–3.

    CAS  PubMed  Google Scholar 

  • Gattinoni L, Agostoni A, Pesenti A, Pelizzola A, Rossi GP, Langer M, Vesconi S, Uziel L, Fox U, Longoni F, Kolobow T, Damia G. Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2. Lancet Lond Engl. 1980;2:292–4.

    Article  CAS  Google Scholar 

  • Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, Protti A, Gotti M, Chiurazzi C, Carlesso E, Chiumello D, Quintel M. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42:1567–75.

    Article  CAS  PubMed  Google Scholar 

  • Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.

    Article  PubMed  CAS  Google Scholar 

  • Holzgraefe B, Broomé M, Kalzén H, Konrad D, Palmér K, Frenckner B. Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure. Minerva Anestesiol. 2010;76:1043–51.

    CAS  PubMed  Google Scholar 

  • Karagiannidis C, Lubnow M, Philipp A, Riegger GAJ, Schmid C, Pfeifer M, Mueller T. Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med. 2010;36:2038–44.

    Article  PubMed  Google Scholar 

  • Kimmoun A, Roche S, Bridey C, Vanhuyse F, Fay R, Girerd N, Mandry D, Levy B. Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance. Ann Intensive Care. 2015;5:35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kobayashi H, Hataishi R, Mitsufuji H, Tanaka M, Jacobson M, Tomita T, Zapol WM, Jones RC. Antiinflammatory properties of inducible nitric oxide synthase in acute hyperoxic lung injury. Am J Respir Cell Mol Biol. 2001;24:390–7.

    Article  CAS  PubMed  Google Scholar 

  • Kolobow T, Gattinoni L, Tomlinson TA, Pierce JE. Control of breathing using an extracorporeal membrane lung. Anesthesiology. 1977;46:138–41.

    Article  CAS  PubMed  Google Scholar 

  • Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis. 1987;135:312–5.

    CAS  PubMed  Google Scholar 

  • Langer M, Mascheroni D, Marcolin R, Gattinoni L. The prone position in ARDS patients. A clinical study. Chest. 1988;94:103–7.

    Article  CAS  PubMed  Google Scholar 

  • Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology. 1988;69:171–9.

    Article  CAS  PubMed  Google Scholar 

  • Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358:1327–35.

    Article  CAS  PubMed  Google Scholar 

  • Lindén V, Palmér K, Reinhard J, Westman R, Ehrén H, Granholm T, Frenckner B. High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med. 2000;26:1630–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lucchini A, De Felippis C, Pelucchi G, Grasselli G, Patroniti N, Castagna L, Foti G, Pesenti A, Fumagalli R. Application of prone position in hypoxaemic patients supported by veno-venous ECMO. Intensive Crit Care Nurs 2018. https://doi.org/10.1016/j.iccn.2018.04.002.

  • Marhong JD, Telesnicki T, Munshi L, Del Sorbo L, Detsky M, Fan E. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc. 2014;11:956–61.

    Article  PubMed  Google Scholar 

  • Masuda Y, Tatsumi H, Imaizumi H, Gotoh K, Yoshida S, Chihara S, Takahashi K, Yamakage M. Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation. J Artif Organs Off J Jpn Soc Artif Organs. 2014;17:106–9.

    Article  CAS  Google Scholar 

  • Mauri T, Bellani G, Foti G, Grasselli G, Pesenti A. Successful use of neurally adjusted ventilatory assist in a patient with extremely low respiratory system compliance undergoing ECMO. Intensive Care Med. 2011;37:166–7.

    Article  PubMed  Google Scholar 

  • Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J, PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine). Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med. 2016a;42:1360–73.

    Article  PubMed  Google Scholar 

  • Mauri T, Grasselli G, Suriano G, Eronia N, Spadaro S, Turrini C, Patroniti N, Bellani G, Pesenti A. Control of respiratory drive and effort in extracorporeal membrane oxygenation patients recovering from severe acute respiratory distress syndrome. Anesthesiology. 2016b;125:159–67.

    Article  CAS  PubMed  Google Scholar 

  • Mauri T, Langer T, Zanella A, Grasselli G, Pesenti A. Extremely high transpulmonary pressure in a spontaneously breathing patient with early severe ARDS on ECMO. Intensive Care Med. 2016c;42:2101–3.

    Article  PubMed  Google Scholar 

  • Mols G, Loop T, Geiger K, Farthmann E, Benzing A. Extracorporeal membrane oxygenation: a ten-year experience. Am J Surg. 2000;180:144–54.

    Article  CAS  PubMed  Google Scholar 

  • Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, CESAR Trial Collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet Lond Engl. 2009;374:1351–63.

    Article  Google Scholar 

  • Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard J-C, Brun-Buisson C, Brochard L, Research Network REVA. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187:276–85.

    Article  CAS  PubMed  Google Scholar 

  • Scaravilli V, Kreyer S, Belenkiy S, Linden K, Zanella A, Li Y, Dubick MA, Cancio LC, Pesenti A, Batchinsky AI. Extracorporeal carbon dioxide removal enhanced by lactic acid infusion in spontaneously breathing conscious sheep. Anesthesiology. 2016;124:674–82.

    Article  CAS  PubMed  Google Scholar 

  • Schmidt M, Stewart C, Bailey M, Nieszkowska A, Kelly J, Murphy L, Pilcher D, Cooper DJ, Scheinkestel C, Pellegrino V, Forrest P, Combes A, Hodgson C. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43:654–64.

    Article  CAS  PubMed  Google Scholar 

  • Serpa Neto A, Schmidt M, LCP A, Bein T, Brochard L, Beutel G, Combes A, ELV C, Hodgson C, Lindskov C, Lubnow M, Lueck C, Michaels AJ, Paiva J-A, Park M, Pesenti A, Pham T, Quintel M, Marco Ranieri V, Ried M, Roncon-Albuquerque R, Slutsky AS, Takeda S, Terragni PP, Vejen M, Weber-Carstens S, Welte T, Gama de Abreu M, Pelosi P, et al. Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO. Intensive Care Med. 2016;42:1672–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126–36.

    Article  CAS  PubMed  Google Scholar 

  • Yoshida T, Torsani V, Gomes S, De Santis RR, Beraldo MA, Costa ELV, Tucci MR, Zin WA, Kavanagh BP, Amato MBP. Spontaneous effort causes occult pendelluft during mechanical ventilation. Am J Respir Crit Care Med. 2013;188:1420–7.

    Article  PubMed  Google Scholar 

  • Yoshida T, Fujino Y, Amato MBP, Kavanagh BP. Fifty Years of Research in ARDS. Spontaneous breathing during mechanical ventilation. Risks, mechanisms, and management. Am J Respir Crit Care Med. 2017;195:985–92.

    Article  PubMed  Google Scholar 

  • Zanella A, Salerno D, Scaravilli V, Giani M, Castagna L, Magni F, Carlesso E, Cadringher P, Bombino M, Grasselli G, Patroniti N, Pesenti A. A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support. J Crit Care. 2016;36:178–86.

    Article  PubMed  Google Scholar 

  • Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Peirce EC, Thomas AN, Proctor HJ, Drinker PA, Pratt PC, Bagniewski A, Miller RG. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;242:2193–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Authors’ Contribution

JF, EC, and TM conceived and drafted the text; all authors approved the final draft of the report.

Conflicts of Interest

Jacopo Fumagalli: none; Eleonora Carlesso: none; Tommaso Mauri: none.

Author information

Authors and Affiliations

  1. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy

    Jacopo Fumagalli, Eleonora Carlesso & Tommaso Mauri

  2. Dipartimento di Anestesia, Rianimazione ed Emergenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Tommaso Mauri

Authors
  1. Jacopo Fumagalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleonora Carlesso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tommaso Mauri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tommaso Mauri .

Editor information

Editors and Affiliations

  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fumagalli, J., Carlesso, E., Mauri, T. (2021). Ventilation During Veno-Venous Extracorporeal Membrane Oxygenation. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_48

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-73387-2_48

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-73386-5

  • Online ISBN: 978-3-030-73387-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation