ECMO et SDRA : Canulation

Abstract

Initially, extra corporeal membrane oxygenation (ECMO) was a respiratory assistance technique that used a membrane gas exchanger. By extension, ECMO is now a respiratory and cardiorespiratory assistance technique, used in case of respiratory and/or cardiac weakness. The hemodynamic support can be partial or total. ECMO is easily implanted thanks to peripheral vascular approaches. This kind of assistance uses the concept of “blood extracorporeal circulation”. The basic circuit is simple and includes a pump, an oxygenator (allowing CO 2 removal) and peripheral vascular approaches (one for drainage and one for reinjection). It is easy and fast to set up and can be done bedside. Despite recent technological progress, few centers use temporary respiratory assistance. However, some thoracic surgical units use ECMO in the framework of therapeutic interventions (lung transplantation in particular); in addition, some intensive care units use ECMO in the management and treatment of ARDS. In this chapter, we will first present the techniques of ECMO that can be used in the framework of ARDS, then we will describe the material, and finally we will study the area of implantation. In adult pulmonary pathologies, the key point is to develop the notion of “minimal strategy” with the use of an adjuvant partial extracorporeal circulation, allowing ad integrum recovering of patients. In the near future, technological improvement and a better knowledge of indications should improve the prognostic of patients under ECMO.