Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome)

Jd, Hill; Tg, O'brien; Jj, Murray; Dontigny, L; Ml, Bramson; Jj, Osborn; Gerbode, Frank

doi:10.1056/nejm197203232861204

Cited by 939 publications

(305 citation statements)

References 16 publications

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“…In support of this hypothesis, there were numerous reports [80][81][82][83] of favourable outcomes with ECMO as a treatment for adult respiratory failure. This led to the important ECMO trial of 1975-77 [84].…”

Section: Improving the Gas Exchange Efficiency Of Membrane Oxygenatorsmentioning

confidence: 93%

The history of extracorporeal oxygenators*

Lim

2006

Anaesthesia

103

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SummaryExtracorporeal oxygenators are artificial devices that substitute for anatomical lungs by delivering oxygen to, and extracting carbon dioxide from, blood. They were first conceptualised by the English scientist Robert Hooke (1635–1703) and developed into practical extracorporeal oxygenators by French and German experimental physiologists in the 19th century. Indeed, most of the extracorporeal oxygenators used until the late 1970s were derived from von Schroder's 1882 bubble oxygenator and Frey and Gruber's 1885 film oxygenator. As there is no intervening barrier between blood and oxygen, these are called ‘direct contact’ oxygenators; they contributed significantly to the development and practice of cardiac surgery till the 1980s. Membrane extracorporeal oxygenators introduce a gas–permeable interface between blood and oxygen. This greatly decreased the blood trauma of direct‐contact extracorporeal oxygenators, and enabled extracorporeal oxygenators to be used in longer‐term applications such as the intensive therapy of respiratory distress syndrome; this was demonstrably beneficial for neonates but less so for older patients. Much work since the 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high‐performance microporous hollow‐fibre oxygenators that eventually replaced direct‐contact oxygenators in cardiac theatres.

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Section: Improving the Gas Exchange Efficiency Of Membrane Oxygenatorsmentioning

confidence: 93%

The history of extracorporeal oxygenators*

Lim

2006

Anaesthesia

103

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“…In the case of poor pulmonary and cardiac function, the oxygen supply in the aortic arch, the coronary arteries, and the supraaortic vessel branches is limited and can be optimized by an increase in the ECLS flow rate. However, based on the increased aortic resistance, this can result in increased impairment of left ventricular function [1,14].…”

Section: Extracorporeal Life Support (Ecls)mentioning

confidence: 99%

“…Extracorporeal membrane oxygenation was developed in the 1970 s [1]. A significant increase in ECMO treatment was triggered by confirmation of a survival advantage in the CESAR study (conventional ventilatory support versus ECMO for severe adult respiratory failure) [2] and by the H1N1 virus pandemic in 2009 [3].…”

Section: Introductionmentioning

confidence: 99%

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Beck¹,

Burg²,

Heindel³

et al. 2016

Fortschr Röntgenstr

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ABSTR ACTBackground Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation -veno-venous for ECMO and veno-arterial for ECLS -distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. MethodsThe review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)".Results Critical illness-and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function.Key points ▪ Cannula placement is usually documented by radiography. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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“…Extracorporeal gas exchange is an old technique that has recently benefited from major technical improvements [1][2][3]. While venovenous extracorporeal membrane oxygenation (VV-ECMO) might be used for the most severe forms of respiratory failure, lower flow extracorporeal carbon dioxide removal (ECCO 2 R) might be applied in patients with less severe forms of the acute respiratory distress syndrome (ARDS) to allow "ultra-protective" ventilation with lower airway pressures, tidal volume (VT) and respiratory rate [4], as well as in hypercapnic respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

Pesenti

Brodie

2017

Intensive Care Med

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Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases. Older trials are not relevant anymore since the ECMO circuitry was not heparin-coated leading to severe hemorrhagic complications due to high levels of anticoagulation, and because extracorporeal membrane oxygenation (ECMO) and control group patients did not receive lung-protective ventilation. Alternatively, in the more recent CESAR trial, many patients randomized to the ECMO arm did not receive ECMO and no standardized protocol for lung-protective mechanical ventilation existed in the control group. Since these techniques are costly and associated with potentially serious adverse events, there is an urgent need for high-quality data, for which the cornerstone remains randomized controlled trials.

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Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome)

Cited by 939 publications

References 16 publications

The history of extracorporeal oxygenators*

The history of extracorporeal oxygenators*

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Do we need randomized clinical trials in extracorporeal respiratory support? Yes

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