Oxygenation adjustment of ventilator combined with venovenous extracorporeal membrane oxygenation

Abstract

In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VV-ECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.

Keywords

Adjustment / Mechanical ventilation / Oxygen supply / Respiratory failure / VV-ECMO

Author contributions

Principal drafters listed earlier contributed to the draft of the manuscript.

Funding

None.

Ethical approval of studies and informed consent

Not applicable.

Acknowledgements

None.

References

[1] WS 392-2012. Clinical Application of Mechanical Ventilators. Ministry of Health of the People’s Republic of China; 2012.

[2] National Health Commission of the People’s Republic of China. Technical operation standard for adult extracorporeal membrane oxygenation (2024 edition). Accessed September 30, 2025. https://www.nhc.gov.cn/yzygj/c100068/202411/2ae6596f7a9a4c889f1b0004a6f3b543.shtml

[3] Professional Committee of Critical Care Medicine, Respiratory Physicians Branch, Chinese Medical Doctor Association; Critical Care Group, Respiratory Disease Branch, Chinese Medical Association. Recommendations for extracorporeal membrane oxygenation (ECMO) in adult severe respiratory failure. Chin J Tuberc Respir Dis. 2019; 42(9):660-684.

[4] Anesthesia Committee of Chengdu Medical Association, Chongqing Medical Association Anesthesiology Branch. Perioperative mechanical ventilation for adult non-cardiothoracic surgical patients: a Delphi consensus. Huaxi Med. 2024; 39(11):1979-1690. doi:10.7507/1002-0179.202410028

[5] Brodie D, Peek G, MacLaren G, Vercaemst L, Thiagarajan R. Extracorporeal Life Support: The ELSO Red Book, 6th Edition. Extracorporeal Life Support Organization; 2022.

[6] Assouline B, Combes A, Schmidt M. Setting and monitoring of mechanical ventilation during venovenous ECMO. Crit Care. 2023; 27(1):95. doi:10.1186/s13054-023-04372-2

[7] National Health Commission of the People’s Republic of China. Notice on issuing the Operational Specifications for Adult Extracorporeal Membrane Oxygenation (2024 Edition). Accessed August 20, 2025. http://www.nhc.gov.cn/yzygj/c100068/202411/2ae6596f7a9a4c889f1b0004a6f3b543/files/1732873199940_40343.pdf

[8] National Health Commission of the People’s Republic of China. Notice of the general office of the National Health Commission on issuing the National Catalogue of Restricted Medical Technologies and the Specifications for Clinical Application (2022 edition). Accessed August 20, 2025. https://www.nhc.gov.cn/yzygj/c100068/202204/2655831f6f444b00b3e50604e67531f5.shtml

[9] Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO): guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J. 2021; 67(6):601-610. doi:10.1097/MAT.0000000000001432

[10] Combes A, Hajage D, Capellier G, et al.; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378(21):1965-1975. doi:10.1056/NEJMoa1800385

[11] Quintel M, Busana M, Gattinoni L. Breathing and ventilation during extracorporeal membrane oxygenation: how to find the balance between rest and load. Am J Respir Crit Care Med. 2019; 200(8):954-956. doi:10.1164/rccm.201906-1164ED

[12] Joyce CJ, Udy A, Weeden M, Shekar K, Cook DA. What determines the arterial partial pressure of carbon dioxide on venovenous extracorporeal membrane oxygenation? ASAIO J. 2022; 68(8):1093-1103. doi:10.1097/MAT.0000000000001604

[13] Cavayas YA, Munshi L, Del Sorbo L, Fan E. The early change in PaCO₂ after extracorporeal membrane oxygenation initiation is associated with neurological complications. Am J Respir Crit Care Med. 2020; 201(12):1525-1535. doi:10.1164/rccm.202001-0023OC

[14] Abrams D, Schmidt M, Pham T, et al. Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and practice. Am J Respir Crit Care Med. 2020; 201(5):514-525. doi:10.1164/rccm.201907-1283CI

[15] State Administration for Market Regulation, National Standardization Administration. Directives for standardization—Part 1: rules for the structure and drafting of standardizing documents. Accessed September 30, 2025. https://openstd.samr.gov.cn/bzgk/gb/newGbInfo?hcno=C4BFD981E993C417EF475F2A19B681F1