The association of modifiable mechanical ventilation settings, blood gas changes and survival on extracorporeal membrane oxygenation for cardiac arrest

• Published in: Resuscitation 2022-05, Vol.174, p.53-61
• Main Authors: Tonna, Joseph E., Selzman, Craig H., Bartos, Jason A., Presson, Angela P., Ou, Zhining, Jo, Yeonjung, Becker, Lance B., Youngquist, Scott T., Thiagarajan, Ravi R., Austin Johnson, M., Cho, Sung-Min, Rycus, Peter, Keenan, Heather T.
• Format: Article
• Language: English
• Subjects: Adult; Blood gas changes; Cardiopulmonary Resuscitation; Extracorporeal cardiopulmonary resuscitation; Extracorporeal Membrane Oxygenation; Heart Arrest - therapy; Humans; Intensive care; Management; Mechanical ventilation; Post-cannulation care; Prospective Studies; Respiration, Artificial; Retrospective Studies; Ventilation; Ventilatory management
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2022.03.016

Given the relative independence of ventilator settings from gas exchange and plasticity of blood gas values during extracorporeal cardiopulmonary resuscitation (ECPR), do mechanical ventilation parameters and blood gas values influence survival? Observational cohort study of 7488 adult patients with ECPR from the Extracorporeal Life Support Organization (ELSO) Registry. We performed case-mix adjustment for severity of illness and patient type using generalized estimating equation logistic regression to determine factors associated with hospital survival accounting for clustering by center, standardizing variables by 1 standard deviation (SD) of their values. We examined non-linear relationships between ventilatory and blood gas values with hospital survival. Hospital survival was decreased with higher PaO2 on ECMO (OR 0.69, per 1SD increase [95% CI 0.64, 0.74]; p 20 cmH20 (OR 0.69, per 1SD [0.64, 0.75]; p