Paracorporeal Lung Devices: Thinking Outside the Box

Maul, Timothy M.; Nelson, Jennifer S.; Wearden, Peter D.

doi:10.3389/fped.2018.00243

Cited by 7 publications

(8 citation statements)

References 48 publications

(57 reference statements)

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“…However, the in vitro process is technically challenging, takes time, and cannot be produced in urgent settings [198][199][200][201]; the in vivo process is currently not feasible, but ongoing research is promising. Lastly, paracorporeal lung assist devices might be explored in selected cases where traditional ECMO is not an option, although evidence for hybrid approaches is scarce [202].…”

Section: Discussionmentioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted. Conclusions : ECMO is a life support with a potential impact on long-term patients’ outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients’ outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.

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Section: Discussionmentioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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“…Because of the small size and low blood flow ranges, these devices seem well suited to CO2 clearance in the pediatric population and can be incorporated with renal replacement therapy or cytokine filtration. The future of this new group of devices may serve as an alternative to ECMO for bridging patients with critical lung disease to recovery or transplant 16 …”

Section: Paracorporeal Lung Assist Devicesmentioning

confidence: 99%

“…In addition to the increased availability of ECMO centers with the technical capabilities for pediatric and adult respiratory failure, there are several devices that have entered the clinical use that are targeting adult with end-stage lung disease. 16 Interest has grown to apply these devices in adults and children with other chronic respiratory conditions characterized by hypercarbia. 16 There are cur-…”

Section: Par Acorp Ore Al Lung a Ss Is T De Vice Smentioning

confidence: 99%

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Update on ventilation management in the Pediatric Intensive Care Unit

Egbuta

Easley

2021

Pediatric Anesthesia

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Studies have shown that up to 63% of pediatric intensive care unit patients admitted with acute respiratory or cardiorespiratory illness require mechanical ventilation. Mechanical ventilator support can be divided into three phases: initiation, escalation, and resolution. Noninvasive ventilation is typical during the initiation phase in the management of acute pediatric respiratory failure. The major advancements in the use of noninvasive ventilation involve the emergence of high-flow nasal cannula and how widespread the use of high-flow nasal cannula has become in pediatric critical care practice. When high-flow nasal cannula fails, escalation to continuous positive airway pressure or bi-level positive airway pressure is the next step in respiratory care progression. Careful clinical assessment is necessary to avoid delayed escalation between forms of noninvasive support or escalation to intubation and invasive mechanical ventilation. Advancements in conventional mechanical ventilation are centered on optimizing ventilator settings and customizing monitoring with the overarching goal to reduce complications of mechanical ventilation, such as ventilator-induced lung injury. New mechanical ventilator strategies integrating esophageal pressure monitoring, volumetric capnography, and neurally adjusted ventilator assist help to optimize conventional ventilator support. Nonconventional modes of ventilation in the intensive care unit are high-frequency modes and airway pressure release ventilation. Extracorporeal pulmonary support via extracorporeal membrane oxygenation or paracorporeal lung assist devices provides rescue options when conventional and nonconventional methods fail. During resolution of a course of mechanical ventilator support, reliable weaning strategies and extubation readiness testing are lacking in pediatric critical care. Further, timing of tracheostomy, risk reduction in ventilatorinduced lung injury, and decreased sedation requirements in pediatric patients requiring mechanical ventilation in the pediatric intensive care unit are areas of ongoing research.

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“…Their advantage is their portability, making them suitable for extra-hospital use, even in ambulatory patients. 131,132 Regarding conventional extracorporeal membrane oxygenation or extracorporeal carbon dioxide removal, it seems likely that many recent innovations will gradually enter everyday practice, rendering extracorporeal therapy more effective and safe for the patient.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Respiratory Failure

et al. 2020

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This review focuses on the use of veno-venous extracorporeal membrane oxygenation for respiratory failure across all blood flow ranges. Starting with a short overview of historical development, aspects of the physiology of gas exchange (i.e., oxygenation and decarboxylation) during extracorporeal circulation are discussed. The mechanisms of phenomena such as recirculation and shunt playing an important role in daily clinical practice are explained. Treatment of refractory and symptomatic hypoxemic respiratory failure (e.g., acute respiratory distress syndrome [ARDS]) currently represents the main indication for high-flow veno-venous-extracorporeal membrane oxygenation. On the other hand, lower-flow extracorporeal carbon dioxide removal might potentially help to avoid or attenuate ventilator-induced lung injury by allowing reduction of the energy load (i.e., driving pressure, mechanical power) transmitted to the lungs during mechanical ventilation or spontaneous ventilation. In the latter context, extracorporeal carbon dioxide removal plays an emerging role in the treatment of chronic obstructive pulmonary disease patients during acute exacerbations. Both applications of extracorporeal lung support raise important ethical considerations, such as likelihood of ultimate futility and end-of-life decision-making. The review concludes with a brief overview of potential technical developments and persistent challenges.

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Paracorporeal Lung Devices: Thinking Outside the Box

Cited by 7 publications

References 48 publications

Neonatal respiratory and cardiac ECMO in Europe

Neonatal respiratory and cardiac ECMO in Europe

Update on ventilation management in the Pediatric Intensive Care Unit

Extracorporeal Membrane Oxygenation for Respiratory Failure

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