From: Mechanical ventilation during extracorporeal membrane oxygenation
Source | Mechanical ventilation settings | Notes |
---|---|---|
ECMO for severe ARDS | Â | Â |
ELSO guidelines [22] | Reasonable initial ventilator settings during ECMO could be: | ‘These guidelines describe useful and safe practice, but these are not necessarily consensus recommendations. These guidelines are not intended as a standard of care …’ |
 |   • decelerating flow (pressure control) | Once patients stabilize and sedation can be lightened, spontaneous ventilation with pressure support ventilation can be considered |
 |   • modest PEEP (for example, 10 cmH2O) |  |
 |   • low inflation pressure (for example, 10 cmH2O above PEEP) |  |
 |   • respiratory frequency 4 to 5 breaths per minute |  |
European Network of Mechanical Ventilation (REVA) [24] | Volume assist control mode with: | These recommendations were done specifically for patients with H1N1 influenza-induced ARDS |
 |   • PEEP ≥10 cmH2O |  |
 |   • tidal volume reduced to obtain plateau pressure ≤20 to 25 cmH2O |  |
 |   • respiratory rate 6 to 20 cycles/minute |  |
 |   • FiO2 between 30 and 50% |  |
CESAR trial [3] | Lung rest settings with: | Â |
 |   • peak inspiratory pressure 20 to 25 cmH2O |  |
 |   • PEEP between 10 and 15 cmH2O |  |
 |   • respiratory rate 10 cycles/minute |  |
 |   • FiO2 30% |  |
EOLIA trial [72] | Assisted control mode with: | Multicenter, international, randomized, open trial that will evaluate the impact on the morbidity and mortality of ECMO, early instituted after the diagnosis of ARDS with an unfavorable outcome after 3 to 6 hours despite optimal ventilatory management and maximum medical treatment. The trial is still in progress |
 |   • PEEP ≥10 cmH2O |  |
 |   • tidal volume reduced to obtain plateau pressure ≤20 cmH2O |  |
 |   • respiratory rate 10 to 30 cycles/minute |  |
 |   • or APRV with: |  |
 |   • high pressure ≤20 cmH2O |  |
 |   • PEEP ≥10 cmH2O |  |
ECMO for cardiac failure (VA-ECMO) | Â | Â |
ELSO guidelines [22] | ‘Whether the patient is on either venovenous or venoarterial mode, the ventilator should be managed at low settings to allow lung rest’ |  |