Abstract
Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly offered as rescue therapy for patients with severe acute respiratory distress syndrome (ARDS). ECMO provides respiratory gas exchange across a membrane lung to supplement mechanical ventilation through a compromised, noncompliant, native lung. As ECMO itself does not treat the underlying lung injury, the focus of therapy is on supporting native lung recovery. Refining lung-protective mechanical ventilation strategies is critical to reducing ventilator-induced lung injury (VILI) and to achieving improved outcomes on ECMO.
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References
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33. https://doi.org/10.1001/jama.2012.5669.
Duan EH, Adhikari NKJ, D’Aragon F, et al. Management of acute respiratory distress syndrome and refractory hypoxemia. A multicenter observational study. Ann Am Thorac Soc. 2017;14(12):1818–26. https://doi.org/10.1513/AnnalsATS.201612-1042OC.
Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. https://doi.org/10.1001/jama.2016.0291.
Qadir N, Bartz RR, Cooter ML, et al. Variation in early management practices in moderate-to-severe ARDS in the United States: the severe ARDS: generating evidence study. Chest. 2021;160(4):1304–15. https://doi.org/10.1016/j.chest.2021.05.047.
Hill JD, O’Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972;286(12):629–34. https://doi.org/10.1056/NEJM197203232861204.
Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–63. https://doi.org/10.1016/S0140-6736(09)61069-2.
Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med24. 2018;378(21):1965–75. https://doi.org/10.1056/NEJMoa1800385.
Organization TELS. ELSO registry, International Summary; October, 2021. https://www.elso.org/Registry/InternationalSummaryandReports/InternationalSummary.aspx. Accessed 31 Mar 2022.
Combes A, Brodie D, Chen YS, et al. The ICM research agenda on extracorporeal life support. Intensive Care Med. 2017;43(9):1306–18. https://doi.org/10.1007/s00134-017-4803-3.
Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8. https://doi.org/10.1056/NEJM200005043421801.
Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303(9):865–73. https://doi.org/10.1001/jama.2010.218.
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–68. https://doi.org/10.1056/NEJMoa1214103.
Papazian L, Schmidt M, Hajage D, et al. Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Intensive Care Med. 2022;48(3):270–80. https://doi.org/10.1007/s00134-021-06604-x.
Moss M, Huang DT, Brower RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med. 2019;380(21):1997–2008. https://doi.org/10.1056/NEJMoa1901686.
Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): guideline from the extracorporeal life support organization (ELSO). ASAIO J. 2021;67(6):601–10. https://doi.org/10.1097/MAT.0000000000001432.
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(6):956–61. https://doi.org/10.1513/AnnalsATS.201403-100BC.
Schmidt M, Stewart C, Bailey M, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43(3):654–64. https://doi.org/10.1097/CCM.0000000000000753.
Schmidt M, Pham T, Arcadipane A, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. an international multicenter prospective cohort. Am J Respir Crit Care Med. 2019;200(8):1002–12. https://doi.org/10.1164/rccm.201806-1094OC.
Serpa Neto A, Schmidt M, Azevedo LC, 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(11):1672–84. https://doi.org/10.1007/s00134-016-4507-0.
Araos J, Alegria L, Garcia P, et al. Near-apneic ventilation decreases lung injury and fibroproliferation in an acute respiratory distress syndrome model with extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2019;199(5):603–12. https://doi.org/10.1164/rccm.201805-0869OC.
Cavayas YA, Munshi L, Del Sorbo L, Fan E. The early change in Pa. Am J Respir Crit Care Med. 2020;201(12):1525–35. https://doi.org/10.1164/rccm.202001-0023OC.
Combes A, Fanelli V, Pham T, Ranieri VM, investigators ESoICMTGatSoU-PlvwECRfN-OmtsAS. Feasibility and safety of extracorporeal CO. Intensive Care Med. 2019;45(5):592–600. https://doi.org/10.1007/s00134-019-05567-4.
McNamee JJ, Gillies MA, Barrett NA, et al. Effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal vs standard care ventilation on 90-day mortality in patients with acute hypoxemic respiratory failure: the rest randomized clinical trial. JAMA. 2021;326(11):1013–23. https://doi.org/10.1001/jama.2021.13374.
Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747–55. https://doi.org/10.1056/NEJMsa1410639.
Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567–75. https://doi.org/10.1007/s00134-016-4505-2.
Costa ELV, Slutsky AS, Brochard LJ, et al. Ventilatory variables and mechanical power in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2021;204(3):303–11. https://doi.org/10.1164/rccm.202009-3467OC.
Beitler JR, Sarge T, Banner-Goodspeed VM, et al. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-Fio2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2019;321(9):846–57. https://doi.org/10.1001/jama.2019.0555.
Franchineau G, Bréchot N, Lebreton G, et al. 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(4):447–57. https://doi.org/10.1164/rccm.201605-1055OC.
Gurnani PK, Michalak LA, Tabachnick D, Kotwas M, Tatooles AJ. Outcomes of extubated COVID and non-COVID patients receiving awake venovenous extracorporeal membrane oxygenation. ASAIO J. 2022;68(4):478–85. https://doi.org/10.1097/MAT.0000000000001632.
Mustafa AK, Joshi DJ, Alexander PJ, et al. Comparative propensity matched outcomes in severe COVID-19 respiratory failure-extracorporeal membrane oxygenation or maximum ventilation alone. Ann Surg. 2021;274(5):e388–94. https://doi.org/10.1097/SLA.0000000000005187.
Mang S, Reyher C, Mutlak H, et al. Awake extracorporeal membrane oxygenation for COVID-19-induced acute respiratory distress syndrome. Am J Respir Crit Care Med. 2022;205(7):847–51. https://doi.org/10.1164/rccm.202105-1189LE.
Bartlett RH. Physiology of gas exchange during ECMO for respiratory failure. J Intensive Care Med. 2017;32(4):243–8. https://doi.org/10.1177/0885066616641383.
Al-Fares AA, Ferguson ND, Ma J, et al. Achieving safe liberation during weaning from VV-ECMO in patients with severe ARDS: the role of tidal volume and inspiratory effort. Chest. 2021;160(5):1704–13. https://doi.org/10.1016/j.chest.2021.05.068.
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Nickols, A.K., Park, P.K. (2022). Mechanical Ventilation Strategies for Patients on Extracorporeal Membrane Oxygenation Support. In: Hidalgo, J., Hyzy, R.C., Mohamed Reda Taha, A., Tolba, Y.Y.A. (eds) Personalized Mechanical Ventilation . Springer, Cham. https://doi.org/10.1007/978-3-031-14138-6_24
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