A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure

Abstract

IntroductionMortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments.MethodsEfficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure.ResultsA rapid increase of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) from 64 (48 to 86) mmHg to 120 (84 to 171) mmHg and a decrease of PaCO2 from 63 (50 to 80) mmHg to 33 (29 to 39) mmHg were observed after start of the extracorporeal support (P < 0.001). Gas exchange capacity of the device averaged 155 (116 to 182) mL/min for oxygen and 210 (164 to 251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401 to 570) mL to 336 (292 to 404) mL (P < 0.001) and of peak inspiratory pressure from 36 (32 to 40) cmH2O to 31 (28 to 35) cmH2O (P < 0.001). Transfusion requirements averaged 0.8 (0.4 to 1.8) units of red blood cells per day. Sixty-two percent of patients were weaned from the extracorporeal system, and 45% survived to discharge.ConclusionsVeno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure.

Blood Conservation in Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

“…Three studies using modern ECMO technology in patients with severe ARDS reported lower rates of pRBC transfusion than prior studies [37][38][39]. However, their transfusion rates were considerably higher than our cohort:…”

Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

“…ECMO support may also cause frequent, severe and potentially life-threatening complications (Table 2), such as bleeding, infections, intravascular hemolysis, thrombocytopenia or consumption coagulopathy [26,[33][34][35][36].…”

Extracorporeal Pulmonary Support in Severe Pulmonary Failure in Adults

“…At the same time, carbon dioxide is removed effectively, making it possible to reduce the respiratory minute ventilation of patients' native lungs immediately. With a bloodflow of 2.8 L/min ECMO accounts for more than 50% of oxygen consumption and approximately twothirds of carbon dioxide removal (33). If necessary, ECMO can supply a higher proportion of required oxygen, more than 80%, using a higher bloodflow, although this may be accompanied by more complications.…”