• Jonathan D Marhong, Teagan Telesnicki, Laveena Munshi, Lorenzo Del Sorbo, Michael Detsky, and Eddy Fan.
• Interdepartmental Division of Critical Care Medicine, and Department of Medicine, University of Toronto, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
• Ann Am Thorac Soc. 2014 Jul 1;11(6):956-61.

RationaleIn patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear.ObjectivesOur objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO).MethodsWe 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.Measurements And Main ResultsWe 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.ConclusionsAlthough 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.

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