RT Book, Section
A1 Napolitano, Lena M.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107718953
T1 Extracorporeal Lung Support
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107718953
RD 2024/04/16
AB Extracorporeal  membrane  oxygenation  (ECMO)  can  be  used  to  provide  support  to  selected  patients  with  severe  acute  respiratory  failure  and  severe  hypoxemia.The  two  major  ECMO  modalities  are  veno-venous  (VV)  and  veno-arterial  (VA),  but  most  cases  of  extracorporeal  lung  support  use  VV-ECMO.The  prospective,  randomized  Adult  ECMO  study  (CESAR  trial)  reported  a  31%  improved  outcome  in  patients  transported  to  a  specialized  center  for  possible  ECMO  (63%  vs  47%  survival  without  disability;  relative  risk  6-month  death  or  severe  disability  0.69,  95%  CI  0.05-0.97;  RR  death  0.73,  95%  CI  0.52-1.03).Significant  adverse  events  and  complications  can  occur  during  ECMO,  most  related  to  hemorrhage,  but  are  becoming  less  common  with  improved  technology  and  reduced  anticoagulation  requirements.ECMO  is  used  in  patients  with  severe  hypoxemia  related  to  ARDS,  2009  Influenza  A  (H1N1)–associated  ARDS,  trauma,  and  pulmonary  embolus.Survival  to  discharge  in  adult  patients  receiving  ECMO  for  respiratory  failure  is  52%  from  the  Extracorporeal  Life  Support  Organization  (ELSO)  registry.VV-ECMO  is  now  being  used  as  a  therapeutic  option  to  bridge  patients  with  advanced  lung  disease  to  lung  transplantation,  avoiding  the  use  of  mechanical  ventilation  and  allowing  aggressive  physical  rehabilitation.A  new  adult  ARDS  ECMO  multicenter  clinical  trial  has  been  initiated,  entitled  ECM  O  to  rescue  Lung  Injury  in  severe  ARDS  (EOLIA,  Alain  Combes  MD,  Principal  Investigator,  France).ECMO  is  a  complex  critical  care  organ  support  system,  and  requires  an  experienced  and  dedicated  team,  appropriate  equipment,  and  institutional  commitment  and  leadership.The  current  evidence  supports  the  transfer  of  patients  with  severe  hypoxemia  and  ARDS  to  institutions  with  significant  experience  in  ARDS  management  and  with  ECMO  capabilities.