Clinical review: Extracorporeal membrane oxygenation

Abstract

The H1N1 flu pandemic led to a wider use of extracorporeal membrane oxygenation (ECMO), proving its power in hypoxemic emergencies. The results obtained during this pandemic, more than any randomized trial, led to the worldwide acceptance of the use of membrane lungs. Moreover, as centers that applied this technique as rescue therapy for refractory hypoxemia recognized its strength and limited technical challenges, the indications for ECMO have recently been extended. Indications for veno-venous ECMO currently include respiratory support as a bridge to lung transplantation, correction of lung hyperinflation during chronic obstructive pulmonary disease exacerbation and respiratory support in patients with the acute respiratory distress syndrome, possibly also without mechanical ventilation. The current enthusiasm for ECMO in its various aspects should not, however, obscure the consideration of the potential complications associated with this life-saving technique, primarily brain hemorrhage

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

“…ECMO is an external device that supports the cardiopulmonary system by providing oxygenation and cardiac function for a patient in cardiac and respiratory failure. ECMO has been successfully used in all ages for various medical and surgical conditions leading to cardiovascular collapse, respiratory failure, cardiogenic shock, or refractory hypotension [2][3][4][5][6][7][8][9]. ECMO has also been used in poisoning exposures when cardiac arrest or refractory hypotension develops.…”

Immediately Functioning Grafts from Brain-Dead Donors Treated with Extracorporeal Membrane Oxygenation

“…Normally, patients offered this form of treatment are deemed to have good overall organ status before experiencing acute cardiac or respiratory events. 3 In patients in whom ECMO is used to treat cardiac or respiratory failure, the results are encouraging. However, a significant number of patients treated with ECMO do not recover because of either the nonsalvageable nature of their heart or respiratory condition or a neurologic event that sometimes accompanies this form of therapy.…”

Look before leaping into combining extracorporeal techniques to improve oxygenation!

“…No data on cardiac function were provided. According to the Extracorporeal Life Support Organization guidelines, VA-ECMO should be applied exclusively in cardiac failure, whereas venovenous ECMO is first-line therapy for refractory or life-threatening hypoxemia in patients with preserved or drug-sustained cardiac function [2,3]. Venoarterial venous (VAV) ECMO is most appropriate to secure upper body oxygenation in case of severe myocardial dysfunction.…”

“…Venoarterial venous (VAV) ECMO is most appropriate to secure upper body oxygenation in case of severe myocardial dysfunction. Peripheral arterial cannulation for VAV-ECMO is feasible, yet a central approach better ''synchronizes'' perfusion to oxygenation needs by more closely regulating oxygenated blood return to the coronary and cerebral circulation [2,3]. Second, the high metabolic oxygen demands of ARDS patients can only be met by providing a high (i.e., between 3 and 7 L/min) ECMO blood flow rate.…”

“…ECMO flow rates of 500-1500 mL/min effectively remove CO 2 from the circulation but are unsuited for oxygenation purposes. Thus, implementing a CRRT device at a ''meagre'' blood flow rate of 300 mL/min into an ECMO circuit clearly is inadequate for improving oxygen supply [3,4]. Third, embedding a CRRT device in series with an ECMO circuit may have significant drawbacks [5].…”