title: Mechanical ventilation during extracorporeal membrane oxygenation. An international survey.
abstract: BACKGROUND
  In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear.
  
  
  OBJECTIVE
  Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO).
  
  
  METHODS
  We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis.
  
  
  RESULTS
  We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation.
  
  
  CONCLUSIONS
  Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, and Department of Medicine, University of Toronto, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Marhong
authors.forename: Teagan
authors.initials: T
authors.lastname: Telesnicki
authors.forename: Laveena
authors.initials: L
authors.lastname: Munshi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Del Sorbo
authors.forename: Michael
authors.initials: M
authors.lastname: Detsky
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013990:Tidal Volume; D016896:Treatment Outcome
keywords: Extracorporeal Life Support Organization; acute respiratory distress syndrome; extracorporeal membrane oxygenation; international survey; mechanical ventilation