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Mechanical ventilation during extracorporeal life support (ECLS): a systematic review.

Jonathan D Marhong1, Laveena Munshi, Michael Detsky

  • 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, jonathan.marhong@medportal.ca.

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|March 11, 2015
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Extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients often involves reducing mechanical ventilation intensity. This systematic review describes current ventilation practices during ECLS for ARDS, highlighting the need for optimal strategies.

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Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Mechanical Ventilation

Background:

  • Extracorporeal life support (ECLS) is used in acute respiratory distress syndrome (ARDS) to support gas exchange and minimize ventilator-induced lung injury (VILI).
  • Optimal mechanical ventilation settings during ECLS for ARDS remain undefined.
  • Understanding current ventilation practices is crucial for improving patient outcomes.

Purpose of the Study:

  • To systematically review and describe ventilation practices in ARDS patients undergoing ECLS.
  • To identify common ventilation strategies and parameters used in conjunction with ECLS for ARDS.
  • To inform future research on optimal ventilatory strategies during ECLS for ARDS.

Main Methods:

  • Systematic review of electronic databases (MEDLINE, EMBASE, CENTRAL, AMED, HAPI) from inception to January 2015.
  • Inclusion of randomized controlled trials, observational studies, and case series (≥4 patients) involving ARDS patients on ECLS.
  • Focus on studies detailing ventilation practices employed during ECLS for ARDS.

Main Results:

  • Forty-nine studies (2,042 patients) were included.
  • Prior to ECLS, 90% of studies reported injurious ventilation parameters (e.g., high tidal volume or pressure).
  • After ECLS initiation, significant reductions in tidal volume, plateau pressure, and FiO2 were observed, with a median mortality of 41%.

Conclusions:

  • Clinicians commonly reduce mechanical ventilation intensity after initiating ECLS in ARDS patients, likely aiming to decrease VILI.
  • Current ventilation practices during ECLS for ARDS vary.
  • Further research is needed to establish evidence-based, optimal ventilatory strategies for ARDS patients on ECLS.