There is limited data on the respiratory system mechanics and ideal mode of ventilation for patients on veno-arterial extra-corporeal membrane oxygenation (VA ECMO) post cardiac arrest. In this observational study, the investigators will review and/or obtain laboratory, hemodynamic, respiratory system mechanical, and clinical data from patients on VA ECMO. The specific aims of this study are as follows: Aim 1: To characterize the lung ventilation strategy employed in patients on VA ECMO and its success. Aim 2: To characterize respiratory system mechanics while on ECMO using esophageal manometry and Electrical Impedance Tomography (EIT). Aim 3: To characterize right heart function and pulmonary vascular hemodynamics on the employed ventilation strategy. The overarching hypothesis is that fine-tuned individualized ventilation might be superior to an algorithm that does not account for cardiac and pulmonary functions. Therefore, the aims of this study are to identify areas in which the ventilation strategy may theoretically be suboptimal, which will guide future interventional studies investigating alternatives methods of ventilation which may reduce time on the ventilator after cardiac arrest, time in the intensive care unit, and need for veno-venous ECMO.
Study Type
OBSERVATIONAL
VA-ECMO used for resuscitation after cardiac arrest
EIT used to demonstrate ventilation and perfusion distribution in intubated patients on VA-ECMO
Massachusetts General Hospital
Boston, Massachusetts, United States
Percent of total distribution of ventilation by region, on given ventilator settings
EIT will be used to determine the percent of total ventilation occurring in each of four lung quadrants on an axial plane: right upper, left upper, right lower, and left lower.
Time frame: Within 24-48 hours of ECMO cannulation
Time on VA-ECMO
Time frame: 14 days, 90 days
Need to transition to VV-ECMO
Time frame: 14 days, 90 days
Time on mechanical ventilation
Time frame: 14 days, 90 days
Time in ICU
Time frame: 14 days, 90 days
90-day mortality
Time frame: 90 days
Incidence of ventilator-associated pneumonia
Time frame: 14 days, 90 days
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