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. 2024 Sep 4;14(1):138.
doi: 10.1186/s13613-024-01359-2.

Mechanical ventilation settings during weaning from venovenous extracorporeal membrane oxygenation

Maria Teresa Passarelli  1   2 , Matthieu Petit  3 , Roberta Garberi  1   2 , Guillaume Lebreton  4   5 , Charles Edouard Luyt  3   4 , Marc Pineton De Chambrun  3 , Juliette Chommeloux  3 , Guillaume Hékimian  3 , Emanuele Rezoagli  1   2 , Giuseppe Foti  1   2 , Alain Combes  3   4 , Marco Giani  1   2 , Matthieu Schmidt  6   7
Affiliations

Mechanical ventilation settings during weaning from venovenous extracorporeal membrane oxygenation

Maria Teresa Passarelli et al. Ann Intensive Care. .

Abstract

Background: The optimal timing of weaning from venovenous extracorporeal membrane oxygenation (VV ECMO) and its modalities have been rarely studied.

Methods: Retrospective, multicenter cohort study over 7 years in two tertiary ICUs, high-volume ECMO centers in France and Italy. Patients with ARDS on ECMO and successfully weaned from VV ECMO were classified based on their mechanical ventilation modality during the sweep gas-off trial (SGOT) with either controlled mechanical ventilation or spontaneous breathing (i.e. pressure support ventilation). The primary endpoint was the time to successful weaning from mechanical ventilation within 90 days post-ECMO weaning.

Results: 292 adult patients with severe ARDS were weaned from controlled ventilation, and 101 were on spontaneous breathing during SGOT. The 90-day probability of successful weaning from mechanical ventilation was not significantly different between the two groups (sHR [95% CI], 1.23 [0.84-1.82]). ECMO-related complications were not statistically different between patients receiving these two mechanical ventilation strategies. After adjusting for covariates, older age, higher pre-ECMO sequential organ failure assessment score, pneumothorax, ventilator-associated pneumonia, and renal replacement therapy, but not mechanical ventilation modalities during SGOT, were independently associated with a lower probability of successful weaning from mechanical ventilation after ECMO weaning.

Conclusions: Time to successful weaning from mechanical ventilation within 90 days post-ECMO was not associated with the mechanical ventilation strategy used during SGOT. Further research is needed to assess the optimal ventilation strategy during weaning off VV ECMO and its impact on short- and long-term outcomes.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Mechanical ventilation; Spontaneous breathing; Weaning.

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Conflict of interest statement

Matthieu Schmidt reports lecture fees from Getinge, Dräger, Baxter, and Fresenius Medical Care outside the submitted work. Alain Combes reports grants from Getinge, and personal fees from Getinge, Baxter, and Xenios outside the submitted work. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flowchart. ARDS, acute respiratory distress syndrome; V-A, ECMO veno-arterial extracorporeal membrane oxygenation; V-V ECMO, venovenous extracorporeal membrane oxygenation
Fig. 2
Fig. 2
Cumulative incidence function for the events of mechanical ventilation successful weaning and death or second run of ECMO, according to mechanical ventilation modalities during sweep gas-off trial. sHR, subdistribution hazard ratio; MV, mechanical ventilation
Fig. 3
Fig. 3
Association of covariates with the 90-day adjusted probability of successful weaning from mechanical ventilation after ECMO decannulation in the multivariable model, expressed using sHR (points) with their 95% CI (error bars). sHR, subdistribution hazard ratio. The model was performed on 355 patients due to missing data
See this image and copyright information in PMC

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