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Article

The Ventilatory Ratio as a Predictor of Successful Weaning from a Veno-Venous Extracorporeal Membrane Oxygenator

by
Anna Fischbach
1,*,
Steffen B. Wiegand
2,
Julia Alexandra Simons
1,
Liselotte Ammon
1,
Rüdger Kopp
3,
Guillermo Ignacio Soccoro Matos
4,
Julio Javier Baigorri
4,
Jerome C. Crowley
4 and
Aranya Bagchi
4
1
Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
2
Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
3
Department of Operative Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
4
Department of Anesthesiology, Massachusetts General Hospital, Boston, MA 02114, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(13), 3758; https://doi.org/10.3390/jcm13133758
Submission received: 9 April 2024 / Revised: 11 June 2024 / Accepted: 24 June 2024 / Published: 27 June 2024
(This article belongs to the Special Issue Extracorporeal Membrane Oxygenation (ECMO): Clinical Challenges and Opportunities)
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Abstract

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a critical intervention for patients with severe lung failure, especially acute respiratory distress syndrome (ARDS). The weaning process from ECMO relies largely on expert opinion due to a lack of evidence-based guidelines. The ventilatory ratio (VR), which correlates with dead space and mortality in ARDS, is calculated as [minute ventilation (mL/min) x arterial pCO2 (mmHg)]/[predicted body weight × 100 × 37.5]. Objectives: The aim of this study was to determine whether the VR alone can serve as a reliable predictor of safe or unsafe liberation from VV-ECMO in critically ill patients. Methods: A multicenter retrospective analysis was conducted, involving ARDS patients undergoing VV-ECMO weaning at Massachusetts General Hospital (January 2016 – December 2020) and at the University Hospital Aachen (January 2012–December 2021). Safe liberation was defined as no need for ECMO recannulation within 48 h after decannulation. Clinical parameters were obtained for both centers at the same time point: 30 min after the start of the SGOT (sweep gas off trial). Results: Of the patients studied, 83.3% (70/84) were successfully weaned from VV-ECMO. The VR emerged as a significant predictor of unsafe liberation (OR per unit increase: 0.38; CI: 0.17–0.81; p = 0.01). Patients who could not be safely liberated had longer ICU and hospital stays, with a trend towards higher mortality (38% vs. 13%; p = 0.05). Conclusions: The VR may be a valuable predictor for safe liberation from VV-ECMO in ARDS patients, with higher VR values associated with an elevated risk of unsuccessful weaning and adverse clinical outcomes.
Keywords: ARDS; ventilatory ratio; extracorporeal membrane oxygenation; weaning ARDS; ventilatory ratio; extracorporeal membrane oxygenation; weaning

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MDPI and ACS Style

Fischbach, A.; Wiegand, S.B.; Simons, J.A.; Ammon, L.; Kopp, R.; Soccoro Matos, G.I.; Baigorri, J.J.; Crowley, J.C.; Bagchi, A. The Ventilatory Ratio as a Predictor of Successful Weaning from a Veno-Venous Extracorporeal Membrane Oxygenator. J. Clin. Med. 2024, 13, 3758. https://doi.org/10.3390/jcm13133758

AMA Style

Fischbach A, Wiegand SB, Simons JA, Ammon L, Kopp R, Soccoro Matos GI, Baigorri JJ, Crowley JC, Bagchi A. The Ventilatory Ratio as a Predictor of Successful Weaning from a Veno-Venous Extracorporeal Membrane Oxygenator. Journal of Clinical Medicine. 2024; 13(13):3758. https://doi.org/10.3390/jcm13133758

Chicago/Turabian Style

Fischbach, Anna, Steffen B. Wiegand, Julia Alexandra Simons, Liselotte Ammon, Rüdger Kopp, Guillermo Ignacio Soccoro Matos, Julio Javier Baigorri, Jerome C. Crowley, and Aranya Bagchi. 2024. "The Ventilatory Ratio as a Predictor of Successful Weaning from a Veno-Venous Extracorporeal Membrane Oxygenator" Journal of Clinical Medicine 13, no. 13: 3758. https://doi.org/10.3390/jcm13133758

APA Style

Fischbach, A., Wiegand, S. B., Simons, J. A., Ammon, L., Kopp, R., Soccoro Matos, G. I., Baigorri, J. J., Crowley, J. C., & Bagchi, A. (2024). The Ventilatory Ratio as a Predictor of Successful Weaning from a Veno-Venous Extracorporeal Membrane Oxygenator. Journal of Clinical Medicine, 13(13), 3758. https://doi.org/10.3390/jcm13133758

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