Awakening ECMO During Pediatric Extracorporeal Membrane Oxygenation: A Single-center Experience.

Introduction Recently, some centers have used extubation during extracorporeal membrane oxygenation (ECMO) to eliminate barotrauma and volutrauma as a lung rest strategy. This study aims to demonstrate the use of extubation during ECMO in children. Methods This retrospective study was conducted from January 1, 2015, to April 1, 2023, in our pediatric intensive care unit. Results In this study, we presented six cases that were extubated during ECMO support. In addition, we followed 130 pediatric patients on ECMO in the same period. Two patients were primarily diagnosed with cardiomyopathy, one with myocarditis, two with congenital heart defect, and one with necrotizing pneumonia. The median age of patients was 99 (interquartile range 25-75) (16.5-192) months, and all were male. Venoarterial ECMO was connected to 4 patients, and venovenous ECMO was connected to 2 patients. Six patients were extubated during ECMO on the 5^th, 12^th, 3^rd, 4^th, 3^rd and 14^th days of their treatment, respectively. While the patients were extubated, three of them were supported by biphasic positive airway pressure, one was supported by nasal continuous positive airway pressure, and two were provided with supplementary oxygen. Three patients were extubated under ECMO and discharged. Conclusion The risk of mechanical ventilation related complications such as volutrauma and barotrauma could minimized in patients extubated under ECMO. In addition, sedatives, analgesics, and muscle relaxant related complications such as delirium, muscle weakness, or prolonged ventilation could reduced via awake ECMO. Keywords:Extracorporeal membrane oxygenation, extubation, mechanical ventilation, child: [ABSTRACT FROM AUTHOR]