title: International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure.
abstract: BACKGROUND
  No consensus exists on the optimal settings of mechanical ventilation during veno-venous extracorporeal membrane oxygenation (ECMO). Our aim was to describe how mechanical ventilation and related interventions are managed by adult ECMO centres.
  
  
  METHODS
  A cross-sectional, multi-centre, international survey of 173 adult respiratory ECMO centres. The survey was generated through an iterative process and assessed for clarity, content and face validity.
  
  
  RESULTS
  One hundred thirty-three centres responded (76.8%). Pressure control was the most commonly used mechanical ventilation mode (64.4%). Although the median PEEP was 10 cmH2O, 22.6% set PEEP <10 cmH2O and 15.5% used 15-20 cmH2O. In 63% of centres PEEP was fixed and not titrated. Recruitment maneuvres, were never used in 34.1% of centres, or used daily in 13.2%. Centres reported using either a "lung rest" (45.7%), or an "open lung" strategy (44.2%). Only 24.8% used chest CT to guide mechanical ventilation. Adjunctive treatments were never or occasionally used. Only 10% of centres extubated patients on ECMO, mainly in more experienced centres. 71.3% of centres performed tracheostomy on ECMO, with large variability in timing (most frequent on days 6-10). Only 27.1% of ECMO centres had a protocol for mechanical ventilation on ECMO.
  
  
  CONCLUSIONS
  We found large variability in ventilatory practices during ECMO. The clinicians' training background and the centres' experience had no influence on the approach to ventilation. This survey shows that well conducted studies are necessary to determine the best practice of mechanical ventilation during ECMO and its impact on patient outcome.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London and Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK - luigi.camporota@gstt.nhs.uk.
authors.forename: L
authors.initials: L
authors.lastname: Camporota
authors.forename: E
authors.initials: E
authors.lastname: Nicoletti
authors.forename: M
authors.initials: M
authors.lastname: Malafronte
authors.forename: M
authors.initials: M
authors.lastname: De Neef
authors.forename: V
authors.initials: V
authors.lastname: Mongelli
authors.forename: M A
authors.initials: MA
authors.lastname: Calderazzo
authors.forename: E
authors.initials: E
authors.lastname: Caricola
authors.forename: G
authors.initials: G
authors.lastname: Glover
authors.forename: C
authors.initials: C
authors.lastname: Meadows
authors.forename: C
authors.initials: C
authors.lastname: Langrish
authors.forename: N
authors.initials: N
authors.lastname: Ioannou
authors.forename: D
authors.initials: D
authors.lastname: Wyncoll
authors.forename: R
authors.initials: R
authors.lastname: Beale
authors.forename: M
authors.initials: M
authors.lastname: Shankar-Hari
authors.forename: N
authors.initials: N
authors.lastname: Barrett
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D014139:Tracheostomy