Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review

Matthieu Schmidt,Carol Hodgson,Alain Combes

doi:10.1186/s13054-015-0806-z

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Highlights

Mechanical ventilation remains the cornerstone of respiratory support for patients with acute respiratory failure
Gattinoni et al reported in 1986 the first cohort of 43 patients with severe acute respiratory distress syndrome (ARDS) treated with veno-venous, low flow (200–300 ml/min) Extracorporeal carbon dioxide removal (ECCO2R), which needed a boot volume of almost two liters of blood [67]
We report the results of 56 studies evaluating extracorporeal gas exchange techniques (ECMO or ECCO2-R) to treat moderate to severe acute respiratory failure in adult patients

Summary

Introduction

Mechanical ventilation remains the cornerstone of respiratory support for patients with acute respiratory failure. Extracorporeal gas exchange devices, i.e., venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), were developed more than 40 years ago [4,5] to rescue these dying patients. Whereas venovenous ECMO provides complete extracorporeal blood oxygenation and decarboxylation using high blood flows (4–6 l/min) and large (20–30 Fr) cannulas [6,7,8,9], efficient extracorporeal CO2 removal (with minimal blood oxygenation) can be achieved with ECCO2R devices using limited extracorporeal blood flow (0.4–1 l/min) and thin double lumen venous catheters (14–18 Fr) [10,11], because CO2 clearance is more effective than oxygenation due to the greater solubility and more rapid diffusion of CO2 [12]. Extracorporeal gas exchange devices permit ‘ultraprotective’ mechanical ventilation with further

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Results

Conclusion