Extracorporeal life support for adults with acute respiratory distress syndrome
Open Access
- 1 December 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 46 (12), 2464-2476
- https://doi.org/10.1007/s00134-020-06290-1
Abstract
Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO2R) uses lower blood flow rates through smaller cannulae and provides substantial CO2 elimination (similar to 20-70% of total CO2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO2R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.This publication has 82 references indexed in Scilit:
- The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndromeIntensive Care Medicine, 2013
- Extracorporeal Membrane Oxygenation for Pandemic Influenza A(H1N1)–induced Acute Respiratory Distress SyndromeAmerican Journal of Respiratory and Critical Care Medicine, 2013
- Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDSIntensive Care Medicine, 2013
- Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adultsIntensive Care Medicine, 2013
- The Adult Respiratory Distress Syndrome Cognitive Outcomes StudyAmerican Journal of Respiratory and Critical Care Medicine, 2012
- Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress SyndromeJAMA, 2009
- Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trialThe Lancet, 2009
- Blood acidification enhances carbon dioxide removal of membrane lung: an experimental studyIntensive Care Medicine, 2009
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective studyJAMA, 1979