The Use of Extracorporeal Membrane Oxygenation (ECMO) and Protective Mechanical Ventilation in the Treatment of Acute Respiratory Failure

Abstract

Acute respiratory failure (ARF) affects 2 million people in the United States each year. The ARF's hallmark is a heterogeneous injury, with normal tissue intermingled with a large volume of low compliance and collapsed tissue. Mechanical ventilation is necessary to oxygenate and ventilate those patients but if set inappropriately can cause ventilator-induced lung injury (VILI). To avoid VILI, extracorporeal membrane oxygenation (ECMO) can replace the pulmonary function of gas exchange . The optimal method of mechanical ventilation for the patient on ECMO is unknown. Rest the Lung Approach (RLA) buys time for the lung to heal in the collapsed state. Open Lung Approach (OLA) attempts to open the entire lung very quickly. ARDS-related mortality has not been further reduced using the RLA and even it increases with OLA. Thus, the Mechanical Breath Profile (MBP) component of time would play a critical role in both lung opening and collapses. The Time-Controlled Adaptive Ventilation (TCAV) method of setting and adjusting the Airway Pressure Release Ventilation (APRV) mode uses an extended time at inspiration to open viscoelastic lung tissue and a very brief expiratory time to prevent re-collapse during exhalation. The expiratory time is personalized and adaptive as it is set by changes in respiratory system compliance (CRS). The TCAV method is a novel Stabilize the Lung Approach (SLA). We postulate that the SLA TCAV method would be a highly lung-protective ventilation strategy that would protect from VILI and gradually reopen the lung allowing the patient to be liberated from ECMO.