Venovenous extracorporeal membrane oxygenation for acute respiratory failure
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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.
KeywordsCritical 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.
- 10.Combes A, Brodie D, Bartlett R et al (2014) Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med 190:488–496Google Scholar
- 15.Pham T, Combes A, Chevret S et al (2013) Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med 187:276–285. doi: 10.1164/rccm.201205-0815OC
- 18.Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768. doi: 10.1164/rccm.201109-1599OC
- 19.Barbaro RP, Odetola FO, Kidwell KM et al (2015) Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the Extracorporeal Life Support Organization registry. Am J Respir Crit Care Med 191:894–901. doi: 10.1164/rccm.201409-1634OC CrossRefPubMedGoogle Scholar
- 25.Lubnow M, Philipp A, Foltan M et al (2014) Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange—retrospective analysis of 265 cases. PLoS One 9:e112316. doi: 10.1371/journal.pone.0112316 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Peek GJ, Mugford M, Wilson A et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363. doi: 10.1016/S0140-6736(09)61069-2 CrossRefPubMedGoogle Scholar
- 35.Schmidt M, Bailey M, Sheldrake J et al (2014) Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med 189:1374–1382. doi: 10.1164/rccm.201311-2023OC CrossRefPubMedGoogle Scholar
- 52.Chu DC, Abu-Samra AG, Baird GL et al (2015) Quantitative measurement of heparin in comparison with conventional anticoagulation monitoring and the risk of thrombotic events in adults on extracorporeal membrane oxygenation. Intensive Care Med 41:369–370. doi: 10.1007/s00134-014-3574-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Lynch WR, MacLaren G, Wilson JM, Bartlett RH (2012) ECMO: extracorporeal cardiopulmonary support in critical care, 4 edn. Extracorporeal Life Support Organization, Ann ArborGoogle Scholar
- 67.Fan E, Pham T (2014) Extracorporeal membrane oxygenation for severe acute respiratory failure: yes we can! (But should we?). Am J Respir Crit Care Med 189:1293–1295. doi: 10.1164/rccm.201404-0711ED