Examine the use of Extracorporeal Membrane Oxygenation (ECMO) and the patterns of mode transitions during ICU admission: A Retrospective Study.

Abstract

Introduction

Extracorporeal membrane oxygenation (ECMO) is increasingly being used as a rescue therapy for severe respiratory or cardiac failure that is refractory to conventional management. However, transitioning between different ECMO modes (venovenous vs venoarterial) during the ICU admission is not well studied. This retrospective study aimed to examine the patterns of ECMO mode transitions and associated outcomes in patients receiving ECMO support during ICU admission.

Methods:
A retrospective review of ECMO data from 1484 ICU admissions between September 2020 to December 2020 was conducted from 26 hospitals in Saudi Arabia. Demographic data, clinical indications, ECMO details including mode of initiation, changes in mode and configuration, maximum blood and sweep gas flows, circuit clotting events, and outcomes were collected. Descriptive statistics and chi-square tests were used to analyze the data.

Results:
Most patients (94%) were initiated on venovenous ECMO. The ECMO mode was changed in only 4 patients (0.3%), with 2 transitions from venovenous to venoarterial and 2 in the reverse direction. The date of mode change was noted for these 4 patients. Maximum blood flows ranged from 2 to 8 L/min, while sweep gas flows ranged from 3 to 10 L/min. Circuit clotting was reported in 7% of cases. Survivors were discharged in 97.7% of cases. No significant associations were found between gender and ECMO details or outcomes using ANOVA.

Conclusion:
This study found that mode transitions between venovenous and venoarterial ECMO during the same ICU admission occurred infrequently. Most patients were successfully rescued with a single ECMO mode. Larger multicenter studies are needed to further understand factors predicting the need for mode changes to optimize ECMO management.