Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

Area of Science:

• Pediatric Critical Care Medicine
• Extracorporeal Membrane Oxygenation
• Mechanical Ventilation

Background:

• Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a life support measure for severe respiratory failure in children.
• Understanding current mechanical ventilation practices during V-V ECMO is crucial for optimizing patient outcomes.
• The Extracorporporeal Life Support Organization (ELSO) registry provides valuable data on V-V ECMO management.

Purpose of the Study:

• To describe current rest mechanical ventilation settings in pediatric patients undergoing V-V ECMO.
• To investigate the association between ventilator settings and mortality in this population.

Main Methods:

• Retrospective review of 1161 pediatric patients (14 days to 18 years) who received V-V ECMO between 2012-2016.
• Analysis of mechanical ventilation data (mode, settings) at 24 hours post-ECMO cannulation.
• Multivariable logistic regression to assess the relationship between rest ventilator settings and mortality.

Main Results:

• 1022 (88%) patients received conventional mechanical ventilation on ECMO.
• Median rest settings: Rate 12 breaths/min, Peak Inspiratory Pressure (PIP) 22 cmH2O, Positive End-Expiratory Pressure (PEEP) 10 cmH2O, Fraction of Inspired Oxygen (FiO2) 0.4.
• Survival to discharge was 68%. Higher FiO2 (OR 1.13 per 0.1 increase) was independently associated with mortality.

Conclusions:

• Pediatric V-V ECMO management commonly employs conventional mechanical ventilation with moderate PIP, PEEP, and FiO2.
• The association between FiO2 and mortality warrants further investigation.
• Optimizing FiO2 settings may be a target for improving survival in pediatric V-V ECMO patients.