{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:41:51Z","timestamp":1781073711081,"version":"3.54.1"},"reference-count":76,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The impact of mechanical ventilation on the survival of patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) due to severe acute respiratory distress syndrome (ARDS) remains still a focus of research<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Recent guidelines, randomized trials, and registry data underscore the importance of lung-protective ventilation during respiratory and cardiac support on ECMO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This approach includes decreasing mechanical power delivery by reducing tidal volume and driving pressure as much as possible, using low or very low respiratory rate, and a personalized approach to positive-end expiratory pressure (PEEP) setting. Notably, the use of ECMO in awake and spontaneously breathing patients is increasing, especially as a bridging strategy to lung transplantation. During respiratory support in V-V ECMO, native lung function is of highest importance and adjustments of blood flow on ECMO, or ventilator settings significantly impact the gas exchange. These interactions are more complex in veno-arterial (V-A) ECMO configuration and cardiac support. The fraction on delivered oxygen in the sweep gas and sweep gas flow rate, blood flow per minute, and oxygenator efficiency have an impact on gas exchange on device side. On the patient side, native cardiac output, native lung function, carbon dioxide production (VCO2), and oxygen consumption (VO2) play a role. Avoiding pulmonary oedema includes left ventricle (LV) distension monitoring and prevention, pulse pressure &gt;10\u00a0mm Hg and aortic valve opening assessment, higher PEEP adjustment, use of vasodilators, ECMO flow adjustment according to the ejection fraction, moderate use of inotropes, diuretics, or venting strategies as indicated and according to local expertise and resources<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Understanding the physiological principles of gas exchange during cardiac support on femoro-femoral V-A ECMO configuration and the interactions with native gas exchange and haemodynamics are essential for the safe applications of these techniques in clinical practice. Proning during ECMO remains to be discussed until further data is available from prospective, randomized trials implementing individualized PEEP titration during proning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591241232270","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T05:35:25Z","timestamp":1713850525000},"page":"107S-114S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Mechanical ventilation during extracorporeal membrane oxygenation support \u2013 New trends and continuing challenges"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2501-4727","authenticated-orcid":false,"given":"Konstanty","family":"Szuldrzynski","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, National Institute of Medicine of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariusz","family":"Kowalewski","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland"},{"name":"Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland"},{"name":"Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy"},{"name":"Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-092X","authenticated-orcid":false,"given":"Justyna","family":"Swol","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"bibr1-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800385"},{"key":"bibr2-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06248-3"},{"key":"bibr3-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61069-2"},{"key":"bibr4-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13748"},{"key":"bibr5-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01960-7"},{"key":"bibr6-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06272-3"},{"key":"bibr7-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13940"},{"key":"bibr8-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-85113-2_10"},{"key":"bibr9-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00736-7"},{"key":"bibr10-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02448-X"},{"key":"bibr11-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1177\/02676591221151034"},{"key":"bibr12-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14261"},{"key":"bibr13-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07050-7"},{"key":"bibr14-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201703-0548ST"},{"key":"bibr15-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202311-2011ST"},{"key":"bibr16-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03192.x"},{"key":"bibr17-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs433"},{"key":"bibr18-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.07.009"},{"key":"bibr19-02676591241232270","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1546429"},{"key":"bibr20-02676591241232270","first-page":"37","volume":"8","author":"Yeo HJ","year":"2016","journal-title":"J Thorac Dis"},{"key":"bibr21-02676591241232270","doi-asserted-by":"crossref","unstructured":"Hermens JA, Braithwaite SA, Platenkamp M, et al. 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