[Extracorporeal membrane oxygenation and CO2 elimination]

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Extracorporeal Life Support

Background:

• Acute Respiratory Distress Syndrome (ARDS) stage IV carries a historically high mortality rate of 90%.
• Previous treatments, including prostaglandin antagonists and antioxidants, have shown limited success in improving ARDS patient outcomes.
• The Morel (1985) classification highlights the severity of ARDS stage IV.

Purpose of the Study:

• To evaluate the efficacy of veno-venous extra-corporeal bypass for CO2-elimination combined with low-frequency positive pressure ventilation in treating severe ARDS patients.
• To determine if this combined method can significantly reduce the high mortality associated with ARDS stage IV.

Main Methods:

• A cohort of 87 ARDS patients (aged 5-51 years) was treated between 1985-1990.
• The treatment involved veno-venous extra-corporeal bypass for carbon dioxide (CO2) removal.
• Patients also received low-frequency positive pressure ventilation, following the Kolobow et al. method.

Main Results:

• Out of 87 treated patients, 46 survived, indicating a significant survival rate.
• The overall mortality rate was reduced from a baseline of 90% to 47%.
• This represents a substantial improvement in patient outcomes compared to historical data.

Conclusions:

• The combined use of extracorporeal CO2-elimination and low-frequency positive pressure ventilation is a superior treatment strategy for severe ARDS.
• This method offers a significant survival advantage for patients with ARDS stage IV.
• The findings challenge previous treatment paradigms and highlight a promising therapeutic option.