Awake ECMO

Awake ECMO

Extracorporeal membrane oxygenation (ECMO) is used for treatment of severe respiratory or cardiopulmonary failure. Usually these patients are sedated and mechanically ventilated, though at lower tidal volumes to reduce lung injury and permit lung recovery.

The concept of Awake ECMO is to do away with mechanical ventilation permitting the patient to eat, drink, sit up and even possibly walk. They can also participate in physiotherapy. One situation in which it is considered is in those who are in bridge to transplantation situation. One study documented 6 month survival after lung transplantation as 80% in the awake ECMO group while it was 50% in the mechanical ventilation group (p=0.02) [1].

Patients on ECMO are the sickest of all patients in a critical care unit.  Spontaneous breathing and early mobilization can reduce the intensive care unit acquired weakness, improve functional recovery, reduce infections and length of hospital stay. But ambulating an awake patient on ECMO is very labour intensive and challenging [2].

A seven year database of peripheral venoarterial ECMO had 231 patients of which 91 had awake ECMO. They had significantly lower rates of pneumonia, tracheostomy, renal replacement therapy and less antibiotic and sedative consumption. It was also associated with reduced 60 day and one year mortality [3].

References

1. Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, Haverich A, Hoeper MM, Warnecke G. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012 Apr 1;185(7):763-8.
2. Haji JY, Mehra S, Doraiswamy P. Awake ECMO and mobilizing patients on ECMO. Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):309-318. doi: 10.1007/s12055-020-01075-z. Epub 2021 Jan 18. PMID: 33487891; PMCID: PMC7811888.
3. Montero S, Huang F, Rivas-Lasarte M, Chommeloux J, Demondion P, Bréchot N, Hékimian G, Franchineau G, Persichini R, Luyt CÉ, Garcia-Garcia C, Bayes-Genis A, Lebreton G, Cinca J, Leprince P, Combes A, Alvarez-Garcia J, Schmidt M. Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):585-594. doi: 10.1093/ehjacc/zuab018. PMID: 33822901.