Current and future status of extracorporeal life support for respiratory failure in adults

Bartlett, Robert H.; Deatrick, Kristopher B

doi:10.1097/mcc.0000000000000274

Cited by 22 publications

(21 citation statements)

References 19 publications

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“…VV-ECMO is indicated in patients with severe respiratory failure that is refractory to optimal mechanical ventilation and medical therapy (5). ECMO for respiratory failure in adults is usually managed with a VV configuration, i.e., blood is drained from the right atrium (RA) or superior vena cava (SVC) and inferior vena cava (IVC) and returned into the RA (6).…”

Section: Indications For Vv-ecmomentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection.While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, 'triple' cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO.

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Section: Indications For Vv-ecmomentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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“…In the last 10-15 years, the application of ECLS has evolved to a mid-term support with awake and spontaneously breathing patients treated in the ICU. 4 Again, this development was supported by technological advances, specifically in the field of oxygenators and pumps, 32 and by novel double-lumen cannulae, making ECLS simpler and safer. 4 As a result, the use of ECLS increased by 433% in the US from 2006 to 2011.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins

Steuer

Hugenroth

Beck

et al. 2020

Cardiovasc Eng Tech

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Purpose-Currently used cannulae for extracorporeal carbon dioxide removal (ECCO 2 R) are associated with complications such as thrombosis and distal limb ischemia, especially for long-term use. We hypothesize that the risk of these complications is reducible by attaching hemodynamically optimized grafts to the patient's vessels. In this study, as a first step towards a long-term stable ECCO 2 R connection, we investigated the feasibility of a venovenous connection to the common iliac veins. To ensure its applicability, the drainage of reinfused blood (recirculation) and high wall shear stress (WSS) must be avoided. Methods-A reference model was selected for computational fluid dynamics, on the basis of the analysis of imaging data. Initially, a sensitivity analysis regarding recirculation was conducted using as variables: blood flow, the distance of drainage and return to the iliocaval junction, as well as the diameter and position of the grafts. Subsequently, the connection was optimized regarding recirculation and the WSS was evaluated. We validated the simulations in a silicone model traversed by dyed fluid. Results-The simulations were in good agreement with the validation measurements (mean deviation 1.64%). The recirculation ranged from 32.1 to 0%. The maximum WSS did not exceed 5.57 Pa. The position and diameter of the return graft show the highest influence on recirculation. A correlation was ascertained between recirculation and WSS. Overall, an inflow jet directed at a vessel wall entails not only high WSS, but also a flow separation and thereby an increased recirculation. Therefore, return grafts aligned to the vena cava are crucial. Conclusion-In conclusion, a connection without recirculation could be feasible and therefore provides a promising option for a long-term ECCO 2 R connection.

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“…Extracorporeal membrane oxygenation (ECMO) is a mobile extracorporeal life support device that provides temporary, complete cardiopulmonary function support [ 3 ]. The respiratory support mode (veno-venous ECMO) gains valuable time to improve pulmonary functions and transition into isolated mechanical ventilation by enhancing oxygenation without increasing average alveolar pressure [ 4 , 5 ]. Positive results reported in a recent multi-central, randomized controlled trial [ 6 ] and subsequent success during an influenza A/H1N1 panepidemic [ 7 – 9 ] has consistently demonstrated that an ECMO-based management protocol significantly improves survival compared to conventional mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center

Huang

et al. 2017

Med Sci Monit

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BackgroundNo definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center’s experience with ECMO and determine predictors of outcome from our Chinese center.Material/MethodsWe retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated.ResultsHemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=−0.463, p=0.03), acute kidney injury (r=−0.574, p=0.005), membrane oxygenator replacement (r=−0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000).ConclusionsECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter-hospital transport can be administered safely.

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Current and future status of extracorporeal life support for respiratory failure in adults

Abstract: ECMO is the next step in the algorithm for management of severe respiratory failure unresponsive to conventional care.

Cited by 22 publications

References 19 publications

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins

Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center

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