Extracorporeal Membrane Oxygenation for Adult Respiratory FailureDiscussion

Abstract

Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that is a mainstay of therapy in neonatal and pediatric patients with life threatening respiratory and/or cardiac failure. Historically, the use of ECMO in adults has been limited, but recent reports and technological advances have increased utilization and interest in this technology in adult patients with severe respiratory failure. As ECMO is considered in this critically ill population, patient selection, indications, contraindications, comorbidities, and pre-ECMO support are all important considerations. Once the decision is made to cannulate a patient for ECMO, meticulous multiorgan-system management is required, with a priority being placed on lung rest and minimization of ventilator-induced lung injury. Close monitoring is also necessary for complications, some of which are related to ECMO and others secondary to the patient's underlying degree of illness. Despite the risks, reports demonstrate survival > 70% in some circumstances for patients requiring ECMO for refractory respiratory failure. As the utilization of ECMO in adult patients with respiratory failure continues to expand, ongoing discussion and investigation are needed to determine whether ECMO should remain a "rescue" therapy or if earlier ECMO may be beneficial as a lung-protective strategy.

Acute Intraoperative Pulmonary Aspiration

“…There are no published studies to date regarding the success of this strategy in adults who suffer immediate cardiac arrest subsequent to massive aspiration and recovery in this setting is highly unlikely. Based on studies of ECMO for ARDS in adults, 26–28 a theoretical benefit for patients who subsequently develop ARDS secondary to intraoperative aspiration may exist. The decision to implement ECMO in this situation depends on the availability of ECMO, the reversibility of the underlying disease process and the severity of associated comorbid conditions.…”

“…The decision to implement ECMO in this situation depends on the availability of ECMO, the reversibility of the underlying disease process and the severity of associated comorbid conditions. 28 …”

A case of ARDS due to Legionella Pneumonia treated with ECMO

“…Solunumsal diyaliz olarak da isimlendirilen yöntem ile çift lümenli kanül venovenöz (VV) ya da venoarteryel (VA) olarak hastaya yerleştirilmektedir. Hastadan gaz değişim ünitesine belli akım hızında kan akışı sağlanarak kan oksijenlendirilmekte, oksijenlenmiş kan hastaya gönderilmektedir (7). Hemodinamik olarak destek gereken olgularda venoarteryel kanülasyon öne-rilmektedir (6).…”

“…Hastamızda izlemi sırasında önemli bir komplikasyon izlenmedi. Solunum yetmezliği olan olgularda %70'in üzerinde ECMO başarısı bildirilmiştir (7). ECMO başarı-sında doğru uygulama, uygun hasta seçimi, uygun takip ve zamanlama önemlidir.…”

Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department

“…ECMO in severe acute respiratory distress syndrome allows lungprotective ventilation by allowing rest ventilator settings and externally controlling gas exchange. 103 Although previous trials had negative results, recent improvements in membrane technology and catheter systems have led to renewed interest. 104 A multicenter randomized controlled trial showed benefit in patients referred to an ECMO center for "consideration of ECMO" compared with standard therapy at the referring center.…”