Abstract
Management of acute respiratory distress syndrome due to viral outbreak includes lower tidal volumes, lower inspiratory pressure, prone ventilation and conservative fluid management. Extracorporeal membrane oxygenation (ECMO) has been proposed as rescue therapy in critically ill patients.However, in the absence of larger studies, the role of ECMO in reducing patient mortality rates remains unclear, since studies that reported such effect, both during the current as well as during previous outbreaks, were based on small sample sizes and their results are inconsistent. Furthermore, the use of ECMO might even be contraindicated in the presence of some conditions. Recurring to it has therefore to be discussed by qualified multi-disciplinary teams and based on a case by case strategy.
Highlights
Management of acute respiratory distress syndrome due to viral outbreaks includes lower tidal volumes, lower inspiratory pressure, prone ventilation, and conservative fluid management
EOLIA and CESAR Trials The randomized EOLIA (ECMO to rescue acute lung injury in severe ARDS) trial involving patients with severe acute respiratory distress syndrome stated that the analysis of the primary endpoint showed no significant benefit of early Extracorporeal membrane oxygenation (ECMO) as compared with conventional mechanical ventilation; ECMO is safe and not associated with significantly higher mortality than standard management
In the CESAR trial (Randomized controlled trial and economic evaluation Controlled Trial of Conventional Ventilatory Support vs. Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure), a large multicenter randomized trial comparing consideration for ECMO versus conventional therapy for treating severe acute respiratory failure in adults, 180 patients were enrolled from 68 centers throughout the United Kingdom over a 5-year period (2001–2006)
Summary
Management of acute respiratory distress syndrome due to viral outbreaks includes lower tidal volumes, lower inspiratory pressure, prone ventilation, and conservative fluid management. ECMO, known as extracorporeal life support, is a form of cardiopulmonary support that may be indicated in cases of reversible acute severe cardiac or pulmonary failure unresponsive to conventional management. ECMO does not provide direct support for organs other than the lungs or heart beyond increasing systemic oxygen delivery and mitigating ventilator induced lung injury [3].
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