Extracorporeal support of oxygenation and ventilation

The management of the patient with respiratory failure is instituted in step-wise fashion. Each successive step requires higher levels of intervention. The final level of support when all conventional means fail is the use of ECMO. The specific method of extracorporeal support may or may not be important in determining ultimate outcome. However, the means of ventilator support during extracorporeal support is controversial. No study has shown a beneficial effect of one method over another. The avoidance of further barotrauma and high oxygen concentration is the keystone to individual ventilator management. The method of introducing extracorporeal devices on to a patient's cardiovascular circuit varies. The technical aspects differ from institution to institution and may reflect surgeon preference. However, all methods are relatively quick and efficient. The amount of personnel needed to manage an extracorporeal circuit varies from institution to institution but nonetheless requires extra people and equipment. The cost of instituting this type of therapy is high. And, although the cost efficiency of ECMO has not been closely analyzed, it is hoped that the judicious use of this technology will produce a favorable result.