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

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’