[Extracorporeal pulmonary support procedures in intensive care medicine 2014]

In recent years a rapid expansion of extracorporeal devices for support of severe lung failure has been witnessed. Systems for veno-venous extracorporeal membrane oxygenation (VV-ECMO) or for extracorporeal carbon dioxide elimination are distinguished depending on the indications.

The state of the art of extracorporeal lung support is presented with an overview of the different systems, the indications, efficiency and potential side effects.

By means of a selective literature research and based on personal experience, the principles and techniques, efficiency and potential side-effects of the new modalities are described.

The VV-ECMO systems may be indicated in severe, refractory and predominantly hypoxemic lung failure (pAO2/FIO2 <80 mmHg). Both life-saving gas exchange and a reduction of ventilator-induced lung injury by means of a more protective ventilation can be achieved. Experienced centers can obtain survival rates of more than 60%. Either pumpless arterio-venous devices, also called interventional lung assist (ILA) or low-flow ECMO devices can be used for extracorporeal carbon dioxide elimination in refractory respiratory acidosis. Severe complications can occur with all modalities of extracorporeal support and have to be rapidly recognized and controlled. It must be pointed out that secure evidence based on prospective randomized studies is currently limited for all modalities.

Modern extracorporeal lung support devices allow an effective extracorporeal gas exchange and have become an inherent component of intensive care treatment of critically ill patients. Due to potentially severe complications the use should be restricted to specialized centers with experience in the treatment of severe acute respiratory distress syndrome (ARDS).