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Table 1 Actual experts’ opinion regarding mechanical ventilation management with extracorporeal membrane oxygenation

From: Mechanical ventilation during extracorporeal membrane oxygenation

Source Mechanical ventilation settings Notes
ECMO for severe ARDS   
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:  
    • 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)   
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’  
  1. APRV airway pressure release ventilation, ARDS adult respiratory distress syndrome, ELSO Extracorporeal Life Support Organization, ECMO extracorporeal membrane oxygenation, FiO 2 Fraction of inspired oxygen, PEEP positive end-expiratory pressure, VA-ECMO venoarterial extracorporeal membrane oxygenation.