ECMO for Adults with Severe Respiratory Failure

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Jonathan Kozinn¹, W Cole Wrisinger¹

¹Jonathan Kozinn, MD and W. Cole Wrisinger, DO, are in the Department of Anesthesiology, Saint Luke's Hospital, University of Missouri - Kansas City, Kansas City, Missouri.

Missouri Medicine

|March 14, 2019

Abstract:

The technology to provide Extracorporeal Life Support (ELS) has existed for over four decades. Its use has increased markedly in the last decade, initially in response to severe Acute Respiratory Distress Syndrome (ARDS) in adults during the 2009 H1N1 influenza epidemic and continuing with the increasing acceptance of Extracorporeal Membrane Oxygenation (ECMO) for the treatment of severe respiratory failure in adults from other causes.1 We highlight the use of ECMO, particularly at our institution.

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Acute Respiratory Failure-I

Acute Respiratory Failure-I

Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...

Acute Respiratory Failure-II

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:

Acute Respiratory Failure-V

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...

Acute Respiratory Failure-III

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...

Acute Respiratory Failure-IV

Acute Respiratory Failure-IV

Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...

Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure

Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure

Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...

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