Intensive Care Medicine

, Volume 42, Issue 5, pp 712–724 | Cite as

Venovenous extracorporeal membrane oxygenation for acute respiratory failure

A clinical review from an international group of experts
  • Eddy FanEmail author
  • Luciano Gattinoni
  • Alain Combes
  • Matthieu Schmidt
  • Giles Peek
  • Dan Brodie
  • Thomas Muller
  • Andrea Morelli
  • V. Marco Ranieri
  • Antonio Pesenti
  • Laurent Brochard
  • Carol Hodgson
  • Cecile Van Kiersbilck
  • Antoine Roch
  • Michael Quintel
  • Laurent Papazian


Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO.


Critical care Extracorporeal membrane oxygenation Intensive care units Respiratory distress syndrome, adult Respiratory failure Review Ventilation, artificial 



We would like to acknowledge Alberto Goffi, MD (Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada) for creating the figures for this manuscript. He was not compensated for this work.

Compliance with ethical standards

Conflicts of interest

Dan Brodie is currently on the medical advisory boards of ALung Technologies and Kadence. All compensation for these activities is paid to Columbia University. Alain Combes received funding for research from Maquet Cardiovascular and is currently on the Medical Advisory Board of Xenios and Baxter. Thomas Müller received fees from Maquet for travel support to invited lectures. Antonio Pesenti received funding for research and travel from Maquet Cardiovascular and is currently on the Medical Advisory Board of Novalung and Baxter. He holds a number of patents related to CO2 removal technology. Matthieu Schmidt received fees from Maquet for lectures. All other authors have no conflicts of interest to declare.

Supplementary material

134_2016_4314_MOESM1_ESM.docx (108 kb)
Supplementary material 1 (DOCX 107 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Eddy Fan
    • 1
    • 2
    Email author
  • Luciano Gattinoni
    • 3
  • Alain Combes
    • 4
  • Matthieu Schmidt
    • 4
  • Giles Peek
    • 5
  • Dan Brodie
    • 6
  • Thomas Muller
    • 7
  • Andrea Morelli
    • 8
  • V. Marco Ranieri
    • 8
  • Antonio Pesenti
    • 3
  • Laurent Brochard
    • 1
    • 9
  • Carol Hodgson
    • 10
  • Cecile Van Kiersbilck
    • 11
  • Antoine Roch
    • 12
  • Michael Quintel
    • 13
  • Laurent Papazian
    • 12
  1. 1.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  2. 2.Extracorporeal Life Support ProgramToronto General HospitalTorontoCanada
  3. 3.Dip Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda, Ospendale Maggiore Policlinico, Dip Fisiopatologia Medico Chirurgica e dei trapiantiUniversita degli Studi di MilanoMilanItaly
  4. 4.Medical Intensive Care Unit, Groupe Hospitalier Pitie-Salpetriere, Institute of Cardiometabolism and NutritionPierre Marie Curie UniversityParisFrance
  5. 5.Division of Pediatric Cardiothoracic Surgery and Pediatric Heart Centre, Montefiore Health SystemAlbert Einstein UniversityNew YorkUSA
  6. 6.Division of Pulmonary, Allergy and Critical Care MedicineColumbia University Medical Center/New York-Presbyterian HospitalNew YorkUSA
  7. 7.Department of Internal Medicine IIUniversity Medical Center of Regensburg, University of RegensburgRegensburgGermany
  8. 8.Department of Anesthesiology and Intensive Care, Policlinico Umberto 1Sapienza University of RomeRomeItaly
  9. 9.Keenan Research Centre, Li Ka-Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  10. 10.Department of Epidemiology and Preventive Medicine, ANZIC-RCMonash University and Physiotherapy Department, The AlfredMelbourneAustralia
  11. 11.Réanimation des Détresses Respiratoires et Infections Sévères, CHU NordAix-Marseille UniversitéMarseilleFrance
  12. 12.Réanimation des Détresses Respiratoires et Infections Sévères, CHU Nord, UMR CNRS 7278Aix-Marseille UniversitéMarseilleFrance
  13. 13.Anaesthesiologie II-Operative IntensivmedizinUniversitatsklinikum GottingenGottingenGermany

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