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Published on: October 24, 2018
Extracorporeal Membrane Oxygenation for Respiratory Failure.
Michael Quintel1, Robert H Bartlett, Michael P W Grocott
1From the Department of Anesthesiology and Intensive Care Medicine, University of Göttingen Medical Center, Göttingen, Germany (M.Q., M.B., L.G.) University of Michigan, Ann Arbor, Michigan (R.H.B.) Perioperative Medicine and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, United Kingdom (M.P.W.G.) Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France (A.C.) Service of Intensive Care, Institute of Cardiology, APHP Hôpital Pitié-Salpêtrière, Paris, France (A.C.) Alma Mater Studiorum - Department of Medical and Surgical Sciences, University of Bologna, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy (M.V.R., M.B.) Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy (S.N.) Department of Medicine, Columbia University College of Physicians and Surgeons, and New York Presbyterian Medical Center, New York, New York (D.B.) Department of Adult Critical Care, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, and Division of Centre of Human Applied Physiological Sciences, King's College London, London, United Kingdom (L.C., F.V.) Department of Pulmonary and Critical Care Medicine, Regions Hospital and University of Minnesota, Minneapolis/St. Paul, Minnesota (J.J.M.).
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) supports respiratory failure. VV-ECMO can be used for oxygenation or carbon dioxide removal, with emerging roles in chronic obstructive pulmonary disease exacerbations.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Cardiopulmonary Support
Background:
- Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life support technology for severe respiratory failure.
- Understanding gas exchange physiology and extracorporeal circulation is crucial for effective VV-ECMO implementation.
- Recirculation and shunt are key phenomena influencing clinical outcomes in VV-ECMO.
Purpose of the Study:
- To review the application of VV-ECMO for respiratory failure across various blood flow ranges.
- To discuss the physiological principles of gas exchange during extracorporeal circulation.
- To explore the role of VV-ECMO in acute respiratory distress syndrome and chronic obstructive pulmonary disease exacerbations.
Main Methods:
- Literature review focusing on veno-venous extracorporeal membrane oxygenation.
- Discussion of physiological mechanisms of gas exchange and extracorporeal support.
- Analysis of clinical indications, including acute respiratory distress syndrome and COPD exacerbations.
Main Results:
- High-flow VV-ECMO is indicated for refractory hypoxemic respiratory failure, such as acute respiratory distress syndrome.
- Low-flow extracorporeal carbon dioxide removal may mitigate ventilator-induced lung injury by reducing lung mechanical power.
- Extracorporeal carbon dioxide removal is an emerging therapy for acute exacerbations of chronic obstructive pulmonary disease.
Conclusions:
- VV-ECMO offers versatile support for respiratory failure, from oxygenation to carbon dioxide removal.
- Ethical considerations, including treatment futility and end-of-life decisions, are paramount in extracorporeal lung support.
- Future developments and persistent challenges in VV-ECMO technology require ongoing investigation.
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