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The following is a summary of “Mechanical ventilation settings during weaning from venovenous extracorporeal membrane oxygenation,” published in the September 2024 issue of Critical Care by Passarelli et al.

Researchers conducted a retrospective study to examine the optimal timing and modalities for weaning from venovenous extracorporeal membrane oxygenation (VV ECMO). 

They conducted a retrospective, multicenter cohort study over 7 years in 2 tertiary ICUs and high-volume ECMO centers in France and Italy. Patients with acute respiratory distress syndrome (ARDS) on ECMO were successfully weaned from VV ECMO. They were categorized on their mechanical ventilation modality during the sweep gas-off trial (SGOT): either controlled mechanical ventilation or spontaneous breathing (i.e., pressure support ventilation). The preliminary endpoint was the time to wean from mechanical ventilation in 90 days post-ECMO weaning successfully.

The results showed 292 patients with severe ARDS, weaned from controlled ventilation, and 101 were on spontaneous breathing during SGOT showed no difference in the 90-day possibility of successful weaning from mechanical ventilation between the 2 groups (sHR [95% CI], 1.23 [0.84 — 1.82]). ECMO-related complications were the same between the 2 groups. After adjusting for covariates, older age, higher pre-ECMO sequential organ failure assessment score, pneumothorax, ventilator-associated pneumonia, and renal replacement therapy, but not mechanical ventilation modalities during SGOT, were independently associated with a lower possibility of successful weaning from mechanical ventilation after ECMO weaning.

The study concluded that the time to successful weaning from mechanical ventilation within 90 days post-ECMO was not linked with the mechanical ventilation strategy used during the SGOT.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01359-2