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An International Survey on Ventilator Practices Among Extracorporeal Membrane Oxygenation Centers

Jenks, Christopher L.*†; Tweed, Jefferson; Gigli, Kristin H.; Venkataraman, Ramgopal§; Raman, Lakshmi‡¶

doi: 10.1097/MAT.0000000000000575
Clinical Critical Care

Although the optimal ventilation strategy is unknown for patients placed on extracorporeal support, there are increasing reports of extubation being used. Our objective was to describe the change in ventilation strategies and use of tracheostomy and bronchoscopy practices among extracorporeal membrane oxygenation (ECMO) centers across the world. A descriptive, cross-sectional 22 item survey of neonatal, pediatric, and adult ECMO centers was used to evaluate ventilator strategies, extubation, bronchoscopy, and tracheostomy practices. Extubation practices are increasing among all types of ECMO centers, representing 27% of all patients in pediatric centers, 41% of all patients in mixed centers, and 52% of all patients in adult centers. The most common mode of ventilation during ECMO is pressure control. There is a trend toward increased use of bilevel ventilation particularly for lung recruitment. Additionally, there is a trend toward increase in performance of bronchoscopy (pediatrics: 69%, mixed centers: 81%, adults: 76%) and tracheostomy. Among the centers performing tracheostomies, 45% reported the percutaneous method (pediatric: 31%, mixed: 46%, adult: 57%), 19% reported the open method (pediatric: 9%, mixed: 27%, adult: 24%), and 10% reported using both types of tracheostomies (pediatric: 2%, mixed: 8%, adult: 16%). Our study shows that ECMO centers are extubating their patients, performing tracheostomies and bronchoscopies on their patients more than in the previous years. There remains significant variation in ECMO ventilator strategies and management internationally. Future studies are needed to correlate these changes in practices to outcome benefits.

From the *Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Texas Children’s Hospital, Houston, Texas; Children’s Medical Center at Dallas part of Children’s Health (SM), Dallas, Texas; §Department of Accounting, University of Texas at Arlington, Arlington, Texas; and Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Submitted for consideration September 2016; accepted for publication in revised form March 2017.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Lakshmi Raman, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390. Email: Lakshmi.raman@utsouthwestern.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs