Predictors of readiness to decannulate patients with acute respiratory failure treated with VV-ECMO

Abstract

Aim: To analyze predictors of readiness to decannulate patients with acute respiratory failure from VV-ECMO. Methods: 227 patients requiring VV-ECMO between 10/2011 to 12/2017 in the medical ICU at the University Hospital Regensburg were retrospectively analyzed. Patients meeting the following weaning criteria (SpO2≥90% on FiO2≤0.4, PEEP≤10 cmH2O, respiratory rate<30/min, tidal volume>5ml/kg, ECMO blood flow~1.5l/min, heart rate<120/min, norepinephrine<0.2µg/kg/min) underwent a weaning trial with pausing sweep gas flow. Ventilatory and respiratory parameters, as well as arterial blood gas analysis were recorded prior, during, and after the weaning trial. Baseline data were recorded at the time of cannulation. Results: 179 of 227 (79%) patients were successfully decannulated. 10 (4%) patients had to undergo a prolonged weaning of at least three failed ECMO weaning trials before successful decannulation. The respiratory rate (19 vs. 16/min, p=0.002) and PaCO2 (44 vs. 40 mmHg, p=0.003) were higher prior to failed than successful trials. Lower PaCO2 (OR [95-CI]: 0.95 [0.91 – 0.999], p=0.045) and lower respiratory rate (OR [95-CI]: 0.91 [0.87 – 0.96], p<0.001) were predictors for successful decannulation in multivariate analysis. Prior to a weaning trial the rapid shallow breathing index (42 vs. 35, p=0.052) was by trend higher in failed trials compared to successful trials. Conclusion: 79% of patients were successfully decannulated from VV-ECMO therapy with 4% of all patients having to undergo a prolonged weaning process of at least three failed weaning trials prior to successful decannulation. Lower aPaCO2 and respiratory rate served as predictors of readiness to decannulate. Footnotes Cite this article as: ERJ Open Research 2022; 8: Suppl. 9, 10. This article was presented at the 2022 ERS Respiratory Failure and Mechanical Ventilation Conference, in session “Poster Session 2”. This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at [www.ers-education.org][1] (ERS member access only). [1]: http://www.ers-education.org