[When mechanical ventilation fails-Venovenous extracorporeal membrane oxygenation]

Area of Science:

• Critical Care Medicine
• Cardiopulmonary Support
• Respiratory Physiology

Context:

• Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a vital rescue therapy for acute respiratory failure.
• It addresses severe oxygenation and decarboxylation impairment when conventional ventilation fails.
• The COVID-19 pandemic significantly increased VV-ECMO utilization and public awareness.

Purpose:

• To outline the primary indications for VV-ECMO, including hypoxic respiratory failure and refractory hypercapnia.
• To detail the mechanism of VV-ECMO, involving blood oxygenation and CO2 removal via a membrane oxygenator.
• To discuss contraindications, complications, and evolving applications such as awake ECMO and ECMO transport.

Summary:

• VV-ECMO utilizes cannulas in central veins to circulate blood through an oxygenator, enhancing oxygen levels and eliminating carbon dioxide.
• Established indications are severe hypoxia (PaO2 < 80 mmHg) and refractory hypercapnia (pH < 7.25, PaCO2 > 60 mmHg) despite protective ventilation.
• Frequent complications include bleeding and thrombosis; advanced age and comorbidities are relative contraindications, while it serves as a bridge to lung transplantation.

Impact:

• Highlights the need for strict quality control and resource management in VV-ECMO to improve patient outcomes.
• Emphasizes the risks associated with untrained personnel performing this resource-intensive procedure.
• Underscores the growing importance of VV-ECMO in managing severe respiratory failure and its potential in lung transplantation.