Issue |
J Extra Corpor Technol
Volume 50, Number 1, March 2018
|
|
---|---|---|
Page(s) | 53 - 57 | |
DOI | https://doi.org/10.1051/ject/201850053 | |
Published online | 15 March 2018 |
Original Articles
High-Frequency Percussive Ventilation Facilitates Weaning from Extracorporeal Membrane Oxygenation in Adults
* Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, New York
† Department of Medicine, New York-Presbyterian Brooklyn Methodist, Brooklyn, New York
‡ Department of Respiratory Therapy, New York-Presbyterian Brooklyn Methodist, Brooklyn, New York
§ Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
Address correspondence to: Iosif Gulkarov, MD, Department of Cardiothoracic Surgery, Staten Island University Hospital, 501 Seaview Avenue, Suite 202, Staten Island, NY 10305. E-mail: igulkarov@northwell.edu
Received:
22
June
2017
Accepted:
17
November
2017
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV. Weaning trials of HFPV a day before decannulation or at the time of separation from VA-ECMO were conducted. Primary endpoint data collected include pre- and post-HFPV partial pressures of oxygen (PaO2) and PaO2/FIO2 (P/F) ratios measured at 2 and 24 hours after institution of HFPV. Additional periprocedural data points were collected including length of time on ECMO, hospital stay, and survival to discharge. Four of five patients were placed on VA-ECMO subsequent to percutaneous coronary intervention. One patient had cardiac arrest secondary to RF. Mean PaO2 (44 ± 15.9 mmHg vs. 354 ± 149 mmHg, p < .01) and mean P/F ratio (44 ± 15.9 vs. 354 ± 149, p < .01) increased dramatically at 2 hours after the initiation of HFPV. The improvement in mean PaO2 and P/F ratio was durable at 24 hours whether or not the patient was returned to MCV (n = 3) or remained on HFPV (n = 2) (44 ± 15.9 mmHg vs. 131 ± 68.7 mmHg, p = .036 and 44 ± 15.9 vs. 169 ± 69.9, p < .01, respectively). Survival to discharge was 80%. The data presented suggest that HFPV may be used as a strategy to shorten time on ECMO, thereby reducing the negative effects of the ECMO circuit and improving its cost efficacy.
Key words: high frequency percussive ventilation (HFPV) / extra-corporeal membrane oxygenation (ECMO) / volume diffusive respirator (VDR) / mechanical conventional ventilation (MCV)
© 2018 AMSECT
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