Mechanical Ventilation in Children on Venovenous ECMO

Area of Science:

• Pediatric critical care medicine
• Respiratory physiology
• Extracorporeal life support

Background:

• Venovenous extracorporeal membrane oxygenation (VV-ECMO) supports patients with severe respiratory failure.
• Optimal mechanical ventilation strategies during VV-ECMO are not well-defined.
• Understanding current practices and their impact is crucial for improving outcomes.

Purpose of the Study:

• To describe mechanical ventilation practices in pediatric patients on VV-ECMO.
• To investigate the association between ventilation strategies and clinical outcomes, particularly survival.

Main Methods:

• Multicenter retrospective cohort study of 10 pediatric centers (2011-2016).
• Included children (14 days to 18 years) on VV-ECMO, excluding specific conditions.
• Analyzed ventilator settings and their correlation with mortality.

Main Results:

• Conventional mechanical ventilation was used in ~75% of patients.
• Significant variation observed in ventilator settings, except PEEP.
• Higher fraction of inspired oxygen (FIO2) on days 1-3 was associated with increased mortality (OR 1.38 per 0.1 increase).
• Mortality was higher with high FIO2 (≥0.5) compared to low FIO2 (<0.5) (46% vs 22%).

Conclusions:

• Ventilator mode and settings show considerable practice variation.
• Fraction of inspired oxygen (FIO2) is the only ventilator setting significantly associated with mortality in pediatric VV-ECMO patients.
• Adjusting FIO2 may be a modifiable factor to reduce mortality in this population.