(1254) Lung Recovery Using APRV-TCAV to Liberate From VV ECMO

Introduction: The goal of emergent VV ECMO is to provide support of gas exchange as a bridge to either recovery of native lung function, or to lung transplant. The optimal strategy for lung recovery is not clear and most ECLS centers apply MV settings with idea of Lung Rest using low TV, low PEEP, and slow rate with minimal FiO2 during VV ECMO.

Methods: Retrospective analysis of patient data collected prospectively of all patients who required emergent VV ECMO for acute respiratory failure with goal of bridge to recovery, and successfully weaned off ECMO. We excluded patients who received V-PA support for isolated RV failure, and those who were identified prior to cannulation as bridge to lung transplantation and were later transferred to transplant centers. We use APRV-TCAV to rescue ARDS patients referred for evaluation avoiding ECMO in most cases when given sufficient time, and use the same strategy to recover lungs in order to liberate from ECMO and MV while minimizing iatrogenic issues (debilitation, delirium, VAP).

Results: 17 patients met criteria. Mean age 44.1; 11 men/6 women; 13 medical/4 trauma. 8 transfers from outside facilities, 3 from MICU, 4 from SICU, 2 from ED. 16/17 went onto ECMO at the time of ECLS consultation due to being in extremis/peri-arrest. Mean total ECMO days 18.4 but when we exclude COVID patients (N=3) it is 9.2 days compared to published data of mean 14-21 days for Non-COVID and 35 days for COVID. Mean total MV days 29.7 but when we exclude COVID patients it is 17.6 days. 15 patients that survived to hospital discharge were liberated from MV; 2 trauma patients had a withdrawal of care 1 week after liberation from ECMO due to severe brain injury. Disposition: Home 53.3% and Acute Rehab 46.7% compared to published literature of Discharge to Home post VV ECMO 33.7%.

Conclusions: When emergent VV ECMO is required for acute severe ARDS, the same strategy utilizing APRV-TCAV that we apply to avoid ECLS in >75% of cases will also facilitate recovery of native lung function allowing for liberation from ECMO and MV. By allowing our patients to be awake with supported spontaneous breathing and ongoing mobilization, we minimize sedation reducing delirium and debilitation giving improved functional outcomes after resolution of ARDS.