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Pulmonary

Research Snapshot Theater: Pulmonary/Resuscitation, Adult and Pediatric

(1251) Difference in First 24 Hours of Mechanical Power on Venovenous Extracorporeal Membrane Oxygenation

Monday, February 24, 2025
9:00am – 10:00am Eastern Time
Location: Connections Central - RST 16

    First Author(s)

  • SD

    Sagar Dave, DO

    Emory University School of Medicine
    Emory University School of Medicine, United States

    • Co-Author(s)

  • TW

    Thomas Whitlark, N/A

    Physician in training
    Emory University School of Medicine, United States

  • SK

    Sharaf Khan, MD,

    Assistant Professor of Emergency Medicine, Assistant Professor of Anesthesiology
    n/a, United States

  • CC

    Christina Creel-Bulos, MD, RN-BSN

    Emory Healthcare
    Atlanta, Georgia, USA

  • DD

    Donias Doko, MD

    Emergency Medicine-Anesthesia Critical Care Medicine Fellow
    Emory University School of Medicine, United States

  • NR

    Nitya Reddy, MD

    Anesthesia Critical Care Medicine Fellow
    Emory University Hospital, United States

  • RL

    Ron Leong, MD,

    Asst Professor, Division of Critical Care, Division of Cardiac Anesthesia, Dept of Anesthesiology
    Emory University, United States

  • EL

    Eric Leiendecker, MD

    ICU Medical Director
    University Hospital, United States

  • DP

    Deepa Patel, MD

    Assistant Professor of Emergency Medicine, Assistant Professor of Anesthesiology
    Emory University Hospital, United States

  • DM

    Donald Maberry, MD

    Asst Prof of Emergency Medicine; Asst Prof of Anesthesiology, Division of Critical Care Medicine
    Emory Healthcare, United States

  • Michael Connor, MD

    Director, Critical Care Nephrology
    Emory University School of Medicine
    Atlanta, Georgia, United States

  • Mark Caridi-Scheible, MD

    Associate Professor, Division of Critical Care Medicine, Department of Anesthesiology
    Emory University Hospital
    Atlanta, Georgia, United States

  • KN

    Katherine Nugent, MD

    SICU Medical Director
    Emory University Hospital
    Atlanta, Georgia, United States

  • BF

    Babar Fiza, MD

    Anesthesia Critical Care Fellowship Director
    Emory Critical Care, United States

  • Craig S. Jabaley, MD, FCCM (he/him/his)

    Emory University Hospital
    Atlanta, Georgia, USA

Introduction: Mechanical power (MP) is the energy exerted on the lungs during invasive mechanical ventilation, which can be decreased after initiating venovenous extracorporeal membrane oxygenation (VV-ECMO) to facilitate lung protective ventilation.

Methods: We retrospectively reviewed all adult VV-ECMO patients admitted from 1/2019-1/2023 to identify patients that remained intubated 24 hours after initiation of VV-ECMO support. Demographics, risk factors, and outcome data were analyzed.

Results: Over the study period, 100 patients remained intubated 24 hours after cannulation. The cohort’s mean age was 44.7 (±14.5) years old, 45% female, had a mean BMI of 36.3 (±11.1), and 38% were diagnosed with COVID-19. Most patients were cannulated remotely (59%). The most common mode of ventilation was volume control (51%) prior to cannulation and pressure control (87%) at 24 hours of VV-ECMO support. Overall unadjusted in-hospital mortality was 22%. Non-survivors had a lower pH prior to cannulation (7.22 [±0.14] vs 7.29 [±0.13]) and more days on ECMO (23.91 [±23.77] vs 12.42 [±13.79], p=0.005). Modifiable and non-modifiable factors were similar prior to cannulation. MP (J/min) was similar between non-survivors and survivors before cannulation [30.33 (16.39) vs 23.62 (16.24), p=0.09] and at 24 hours after cannulation (7.26 [±6.35] vs 9.07 [±7.36], p=0.3].

Non-survivors had a greater reduction in MP (-23.07 [±13.11] vs -14.55 [±17.92], p=0.04) 24 hours after initiating ECMO support. An unadjusted Cox regression analysis demonstrated a significant association between decrease in MP and in-hospital mortality (Hazard Ratio=1.022, CI [1.007-1.0356], p=0.002). The Kaplan-Meier survival analysis showed separation throughout the model.

Conclusions: VV-ECMO can facilitate a decrease in MP by supplementing native gas exchange. In this study, non-survivors had longer duration on ECMO compared to survivors. Along with a lower pre-cannulation pH, a greater decrease in MP in the first 24 hours after cannulation was associated with mortality on an unadjusted basis. These findings suggest that further work is required to better define the optimal approach to mechanical ventilation during VV-ECMO.