Venovenous extracorporeal membrane oxygenation (vv-ECMO) is a highly invasive method for organ support that is gaining in popularity due to recent technical advances and its successful application in the recent H1N1 epidemic. Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise. In this review, we focus on indications for vv-ECMO, components of the circuit, and management of patients on vv-ECMO. Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed. Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

Incorporation of an AV bridge for weaning from veno-arterial ELS is safe and feasible to gradually wean patients with functional cardiac recovery without compromising the circuit integrity.

Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically ill patients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology.

BackgroundExtracorporeal carbon dioxide removal (ECCO2R) has been gaining interest to potentially facilitate gas transfer and equilibrate mild to moderate hypercapnic acidosis, when standard therapy with non-invasive ventilation is deemed refractory. However, concern regarding the effectiveness of low-flow CO2 removal remains. Additionally, the prospect to steadily reduce hypercapnia via low-flow ECCO2R technique is limited, especially with regional anticoagulation which potentially reduces the risk of bleeding. Therefore, an in vivo study was conducted to determine the efficacy of CO2 removal through a modified renal dialysis unit during the carbon dioxide dialysis study using systemic and regional anticoagulation.MethodsThe acute study was conducted for 14 h in landrace pigs (51 ± 3 kg). CO2 removal using a diffusion membrane oxygenator substituting the hemoconcentrator was provided for 6 h. Blood and gas (100 % O2) flows were set at 200 and 5 L/min, respectively. Anticoagulation was achieved by systemic heparinization (n = 7) or regional trisodium citrate 4 % (n = 7).ResultsThe CO2 transfer was highest during the initial hour and ranged from 45 to 35 mL/min, achieving near eucapnic values. Regional and systemic anticoagulation were both effective in decreasing arterial pCO2 (from 8.9 ± 1.3 kPa to 5.6 ± 0.8 kPa and from 8.6 ± 1.0 kPa to 6.3 ± 0.7 kPa, p < 0.05 for both groups, respectively). Furthermore, pH improved (from 7.32 ± 0.08 to 7.47 ± 0.07 and from 7.37 ± 0.04 to 7.49 ± 0.01, p < 0.05) for both regional and systemic anticoagulation groups, respectively. Upon ceasing CO2 dialysis, hypercapnia ensued. The liver and kidney function test results were normal, and scanning electron microscopy analysis revealed only some cellular and fibrin adhesion on the oxygenator fibre in the heparin group.ConclusionsCO2 dialysis utilizing either regional or systemic anticoagulation showed to be safe and effective in steady transfer of CO2 and consequently optimizing pH.