27: Characteristics of Complications in Patients Allowed Spontaneous Breathing During VA-ECMO Treatment

Introduction: Extubation and spontaneous breathing are crucial steps in preventing ventilator-associated pneumonia. However, they can also be associated with the occurrence of a number of dangerous complications that affect patient outcomes (1-3). This study aimed to describe the characteristics of complications in patients allowed spontaneous breathing during VA-ECMO treatment and some related risk factors. Methods: This observational study enrolled 29 patients undergoing VA-ECMO treatment who were extubated and allowed to breath spontaneously in Bach Mai hospital from June 2022 to September 2023. Results: Of the 29 patients included, 41% (12/29) were men and 59% (17/29) were women. The range of ages is 16 to 73 years old, with an average of 43.7 ± 15.6 years. The success rate of extubation and spontaneous breathing was 82.8% (24/29). Complications included: Pain (severe pain accounts for only 6.9%). The rate of delirium was 37.9% (11/29), with most cases being mild (the percentages for RASS scores 1, 2, 3, and 4 are 10.3%, 17.2%, 6.9%, and 3.4%, respectively). Acute pulmonary edema accounted for 44.8%; however, the duration of non-invasive ventilation was 24 [6-92] hours. Iliopsoas hematoma was mostly asymptomatic and discovered incidentally after ECMO weaning. Risk factors for delirium included the use of Fentanyl for more than 48 hours and an increased serum lactate level at 3 hours post-extubation. Risk factors for re-intubation included the use of Fentanyl or sedative for more than 48 hours, an increased serum lactate level at 3 hours post-extubation, and has myocardial infarction, pneumonia, or delirium. Conclusion: The extubation and spontaneous breathing during VA-ECMO treatment are performed with a high success rate and safety. The complications that may occur are generally of low severity.