UMEM Educational Pearls

Category: Critical Care

Title: Mechanical Ventilation During ECMO

Keywords: VV-ECMO, mechanical ventilation, ultra-lung protective ventilation (PubMed Search)

Posted: 2/4/2014 by Mike Winters, MD
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Mechanical Ventilation During ECMO

ECMO is a rapidly emerging therapy for critically ill patients with severe acute respiratory failure (VV-ECMO) and circulatory failure (VA-ECMO).
Mechanical ventilation (MV) settings may have important effects on patients receiving either VV- or VA-ECMO.
Though no large, randomized trials, consensus guidelines and expert opinion recommend the following initial settings for patients receiving VV-ECMO:
- Tidal volume: < 4 ml/kg predicted body weight
- Plateau pressure: < 25 cmH₂O
- PEEP: 10-15 cmH₂O
- F_iO₂: titrated to maintain sats > 85%
- RR: 4 to 6 breaths per minute

Schmidt M, et al. Mechanical ventilation during extracorporeal membrane oxygenation. Crit Care 2014;18:203.