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

Abstract

Background:

We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality.

Methods:

Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality.

Results:

We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH₂O (20,27); positive end expiratory pressure (PEEP) 10 cmH₂O (8, 10); and fraction of inspired oxygen (F_iO₂) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator F_iO₂ (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality.

Conclusions:

Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO₂. Further study on the relationship between FiO₂ and mortality should be pursued.