Extracorporeal membrane oxygenation for acute respiratory distress syndrome.

Toshiyuki Aokage,Kenneth Palmér,Shinhiro Takeda,Shingo Ichiba

doi:10.1186/s40560-015-0082-7

Toshiyuki Aokage, Kenneth Palmér + Show 2 more

Open Access

https://doi.org/10.1186/s40560-015-0082-7

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Abstract

Extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy in patients with refractory severe respiratory failure or cardiac failure. Severe acute respiratory distress syndrome (ARDS) still has a high-mortality rate, but ECMO may be able to improve the outcome. Use of ECMO for respiratory failure has been increasing since 2009. Initiation of ECMO for adult ARDS should be considered when conventional therapy cannot maintain adequate oxygenation. ECMO can stabilize gas exchange and haemodynamic compromise, consequently preventing further hypoxic organ damage. ECMO is not a treatment for the underlying cause of ARDS. Because ARDS has multiple causes, the diagnosis should be investigated and treatment should be commenced during ECMO. Since ECMO is a complicated and high-risk therapy, adequate training in its performance and creation of a referring hospital network are essential. ECMO transport may be an effective method of transferring patients with severe ARDS.

Highlights

Extracorporeal membrane oxygenation (ECMO) can be employed to salvage patients with refractory severe respiratory failure or cardiac failure
The ECMO circuit used in this study could provide full oxygenation and allowed lung rest, which was defined as a peak airway pressure (PIP) of 20–25 cmH2O, positive end-expiratory pressure (PEEP) of 10–15 cmH2O, ventilation rate of 10/min, and FIO2 of 0.3
ECMO, extracorporeal membrane oxygenation; Acute respiratory distress syndrome (ARDS), acute respiratory distress syndrome; PaO2, arterial partial pressure of oxygen; FiO2, fraction of inspired oxygen aIf the patient is a candidate for lung transplantation, ECMO can be considered. bWhile leukaemia is a good indication, ARDS associated with bone marrow transplantation is different

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) can be employed to salvage patients with refractory severe respiratory failure or cardiac failure. In 1986, Gattinoni reported a single-centre observational study of low-frequency positive pressure ventilation with extracorporeal CO2 removal (ECCO2R) that employed the same entry criteria as the above-mentioned RCT and achieved a 30-day survival rate of 48.8% [16]. High-pressure ventilation was required in the ECCO2R group to maintain tidal volume and oxygenation, and ten patients (48%) from this group developed severe bleeding that led to discontinuation of ECMO in seven patients (33%).

Results

Conclusion