[Extracorporeal respiratory assistance (ECRA): initial experiences in Spain]

Area of Science:

• Cardiovascular and Respiratory Medicine
• Pediatric Surgery
• Critical Care Medicine

Background:

• Attendance respiratory extracorporeal (AREC), a form of membrane extracorporeal oxygenation with tidal flow, was first described in 1990.
• This study presents clinical experience with AREC in both veno-venous and veno-arterial configurations.

Observation:

• Three patients with severe cardiorespiratory failure were treated with AREC between October 1997 and the present.
• Two patients had congenital diaphragmatic hernia (CDH) managed with veno-venous AREC, and one infant with ventricular failure underwent veno-arterial AREC.
• The Collin-Cardio pump with a bladder for tidal flow and a 0.8 m2 oxygenator membrane was used in all cases.

Findings:

• Patients with CDH showed initial improvement in lung function after AREC treatment, with one hernia surgically corrected during AREC support.
• Despite AREC support, two CDH patients died within 48 hours of decannulation due to cerebral hemorrhage and respiratory failure.
• The infant with ventricular failure remained stable on veno-arterial AREC for four days before support withdrawal due to absence of cerebral activity.

Implications:

• AREC is a potentially useful and available technique in the country for managing patients with severe cardiorespiratory failure.
• The extreme severity of treated cases and the early phase of the AREC team present limitations to current findings.
• Further research and experience are needed to optimize AREC application in critical care settings.