Mechanical Ventilation during ECMO: Best Practices

Abstract

Adults and children who require extracorporeal membrane oxygenation for respiratory failure remain at risk for ongoing lung injury if ventilator management is not optimized. This review serves as a guide to assist the bedside clinician in ventilator titration for patients on extracorporeal membrane oxygenation, with a focus on lung-protective strategies. Existing data and guidelines for extracorporeal membrane oxygenation ventilator management are reviewed, including non-conventional ventilation modes and adjunct therapies.

Keywords: Mechanical ventilation; acute respiratory distress syndrome; extracorporeal membrane oxygenation; ventilator induced lung injury.

Fig. 1.

Pathophysiology of lung injury.

Fig. 2.

Algorithm to guide management of gas exchange on extracorporeal membrane oxygenation (ECMO) . ${\text{C}}_{{\text{aO}}_{\text{2}}}$ = oxygen carrying capacity; IBW = ideal body weight; ${\text{S}}_{{\text{VO}}_{\text{2}}}$ = mixed venous saturations; VV = veno-venous.