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Venoarterial ECMO in Respiratory Failure

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Extracorporeal Membrane Oxygenation for Adults

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Although venovenous (VV) ECMO is most commonly used to treat respiratory failure, venoarterial (VA) ECMO may also be employed to provide both cardiovascular and respiratory support in patients with respiratory failure associated with hemodynamic instability. VA ECMO is indicated in two broad categories of patients with respiratory failure. The first involves respiratory failure with associated septic, vasoplegic, or cardiogenic shock. In addition to sepsis, pulmonary embolism, myocarditis, intracardiac shunts, or persistent arrhythmias are examples of clinical conditions with both respiratory and cardiovascular failure that may be addressable via VA ECMO. The second category includes patients where oxygenation via VV ECMO alone is inadequate and ongoing cerebral hypoxemia impairs clinical care. In such patients, adding an arterial cannula to the ECMO outflow may reroute oxygenated blood to the aortic arch and permit better cerebral oxygenation. This chapter will review basic principles of VA ECMO, discuss relevant management paradigms for VA ECMO, and suggest how clinicians might choose between VV and VA ECMO for primary respiratory failure.

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA

    Avery Tung

  2. Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA

    Tae H. Song

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  1. Avery Tung
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Correspondence to Avery Tung .

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Editors and Affiliations

  1. Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA

    Gregory A. Schmidt

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Tung, A., Song, T.H. (2022). Venoarterial ECMO in Respiratory Failure. In: Schmidt, G.A. (eds) Extracorporeal Membrane Oxygenation for Adults. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-031-05299-6_16

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  • DOI: https://doi.org/10.1007/978-3-031-05299-6_16

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-031-05298-9

  • Online ISBN: 978-3-031-05299-6

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