Table 3.

Advantages and Disadvantages of Awake Spontaneous Breathing During Extracorporeal Membrane Oxygenation

Advantages	Disadvantages
Prevention of barotrauma	Only performed in experienced ECMO centers
Maintenance of respiratory muscles and diaphragm tone; less impact on functional residual capacity	High work of breathing with increase in oxygen demand and CO2 production
Less V/Q mismatch	Risk of high transpulmonary pressure with the risk of patient self-induced lung injury
Improved venous return due to negative inspiratory pressure	Difficulty in monitoring ventilation parameters and airway pressures
Less sedation	Collapse in IVC during inspiration with difficulties in maintaining ECMO flow
Patient cooperation to treatment	Need for highly skilled teams
Possible reduction of secondary respiratory infections (VAP)	Need for 1:1 nursing
Patients can follow rehabilitation, exercise training and nutrition	Higher costs of care
Patients can better interact with relatives and staff	Need for anticoagulation

Abbreviations: ECMO, extracorporeal membrane oxygenation; IVC, inferior vena cava; P-SILI, patient self-induced lung injury; VAP, ventilator-associated pneumonia; V/Q, ventilation/perfusion.