Mechanical ventilation in veno-venous extracorporeal membrane oxygenation (McVEE)

ECMO is a compact heart-lung machine that can be used in the ICU for months to treat patients with lung failure, e.g. due to COVID-19, who would otherwise almost certainly die. Mortality is also high with ECMO (45%), partly due to lung damage caused by ventilation. Ventilation seems unnecessary because ECMO takes over lung function, but there is discussion. Most doctors give patients anesthesia for weeks to let the ventilator take over the ventilation so that the lungs can 'rest'. The alternative is spontaneous ventilation where the patient is awake and breathing on his or her own. 'Lung rest' is more difficult to impose, but has the advantage that the patient can be mobilized, which prevents muscle weakness (including respiratory muscles). To determine the extent to which patients breathe spontaneously, we will monitor this for a year on all 200 ECMO patients in the Netherlands. We expect survival to be higher if patients breathe spontaneously <72 hours after starting ECMO.