A Review of the Fundamental Principles and Evidence Base in the Use of Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Adult Patients

Allen, Steve; Holena, Daniel N.; McCunn, Maureen; Kohl, Benjamin; Sarani, Babak

doi:10.1177/0885066610384061

Cited by 169 publications

(125 citation statements)

References 98 publications

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“…The systemic blood flow is thus comprised of the extracorporeal ECLS volume and the ejection fraction of the left ventricle [5,6]. In the case of poor pulmonary and cardiac function, the oxygen supply in the aortic arch, the coronary arteries, and the supraaortic vessel branches is limited and can be optimized by an increase in the ECLS flow rate.…”

Section: Extracorporeal Life Support (Ecls)mentioning

confidence: 99%

“…If the tips of the two cannulas are too close together in venovenous ECMO, the blood primarily flows through the extracorporeal circuit from one cannula to the next so that the pulmonary circulation and thus also the systemic circulation primarily receive insufficiently oxygenated blood due to the recirculation [5,13,16,17] (▶ Fig. 4).…”

Section: Cannula Positionmentioning

confidence: 99%

“…If the position of the arterial cannula is too distal in the descending aorta, the oxygen supply of the coronary arteries and the extra-and intracranial arteries can be reduced [5]. Every change in the position of cutaneously fixed cannulas in projection radiography is suspicious for the complication of cannula dislocation [11,16].…”

Section: Cannula Positionmentioning

confidence: 99%

“…Thrombi form primarily at the oxygenator or at the hose connection points, particularly in the case of contraindicated systemic anticoagulation [5]. Thrombi can result in dysfunction of the oxygenator.…”

Section: Thrombus Formation In the Extracorporeal Systemmentioning

confidence: 99%

“…Technical failure of the membrane oxygenator in the case of an increase in thrombus formation or failure of the pump can occur in the case of a long treatment duration so that component replacement must be performed on an emergency basis [5,20].…”

Section: Rare Technical Complicationsmentioning

confidence: 99%

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Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Beck¹,

Burg²,

Heindel³

et al. 2016

Fortschr Röntgenstr

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ABSTR ACTBackground Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation -veno-venous for ECMO and veno-arterial for ECLS -distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. MethodsThe review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)".Results Critical illness-and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function.Key points ▪ Cannula placement is usually documented by radiography. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Section: Extracorporeal Life Support (Ecls)mentioning

confidence: 99%

Section: Cannula Positionmentioning

confidence: 99%

Section: Cannula Positionmentioning

confidence: 99%

Section: Thrombus Formation In the Extracorporeal Systemmentioning

confidence: 99%

Section: Rare Technical Complicationsmentioning

confidence: 99%

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Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Beck¹,

Burg²,

Heindel³

et al. 2016

Fortschr Röntgenstr

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Extracorporeal membrane oxygenation for critically ill adults

Tramm

Ilić

Davies

et al. 2013

Cochrane Database of Systematic Reviews

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Extracorporeal (external to the body) membrane oxygenation (ECMO) for critically ill adultsReview question: E ect of ECMO on survival in critically ill adults.Background: Extracorporeal membrane oxygenation is a form of life support that targets the heart and lungs. For patients with severe lung failure, ECMO provides extracorporeal gas exchange. For those with severe heart failure or cardiac arrest, ECMO (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic blood circulation. Use of ECMO is associated with several risks (e.g. bleeding, clot formation). Study characteristics:We found four studies that randomly allocated 389 patients to receive ECMO versus conventional lung support. All studies comprised patients with acute lung failure. We found no completed study in patients with acute heart failure or arrest. We found one ongoing study in patients with acute lung failure and two ongoing studies in patients with acute heart failure (arrest). The evidence is current to August 2014. Key results: Clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. Individual studies reported no di erences in all-cause death at or before six months in patients given ECMO compared with those who were not. In one study survival was low in both groups but none of the patients who survived had limitations in their daily activities six months a er discharge. Another study found improved survival without severe disability in patients transferred to an ECMO centre for consideration of ECMO six months a er study entry. In three studies, patients in the ECMO group received greater numbers of blood transfusions. One study reported more non-brain bleeding in the ECMO group, and another study reported two serious adverse events in the ECMO group. Another study reported three adverse events in the ECMO group.Quality of the evidence: Clinical practice, study planning and ways of using ECMO have varied considerably among studies. Technological developments (circuits, pumps and mechanical lungs) have improved performance and patient safety with ECMO applications over time. These clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. In critically ill adults, ECMO may or may not be more e ective in improving survival compared with conventional lung support. Results from ongoing studies will help us better understand the role of ECMO and ECPR in the treatment of patients with acute lung or heart failure.

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Extracorporeal membrane oxygenation for critically ill adults

Tramm

Ilić

Davies

et al. 2015

Cochrane Database of Systematic Reviews

109

View full text Add to dashboard Cite

Extracorporeal (external to the body) membrane oxygenation (ECMO) for critically ill adults Review question: E ect of ECMO on survival in critically ill adults. Background: Extracorporeal membrane oxygenation is a form of life support that targets the heart and lungs. For patients with severe lung failure, ECMO provides extracorporeal gas exchange. For those with severe heart failure or cardiac arrest, ECMO (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic blood circulation. Use of ECMO is associated with several risks (e.g. bleeding, clot formation). Study characteristics: We found four studies that randomly allocated 389 patients to receive ECMO versus conventional lung support. All studies comprised patients with acute lung failure. We found no completed study in patients with acute heart failure or arrest. We found one ongoing study in patients with acute lung failure and two ongoing studies in patients with acute heart failure (arrest). The evidence is current to August 2014. Key results: Clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. Individual studies reported no di erences in all-cause death at or before six months in patients given ECMO compared with those who were not. In one study survival was low in both groups but none of the patients who survived had limitations in their daily activities six months a er discharge. Another study found improved survival without severe disability in patients transferred to an ECMO centre for consideration of ECMO six months a er study entry. In three studies, patients in the ECMO group received greater numbers of blood transfusions. One study reported more non-brain bleeding in the ECMO group, and another study reported two serious adverse events in the ECMO group. Another study reported three adverse events in the ECMO group. Quality of the evidence: Clinical practice, study planning and ways of using ECMO have varied considerably among studies. Technological developments (circuits, pumps and mechanical lungs) have improved performance and patient safety with ECMO applications over time. These clinical di erences in the care provided for patients with acute lung failure prevented us from combining the results of individual studies. In critically ill adults, ECMO may or may not be more e ective in improving survival compared with conventional lung support. Results from ongoing studies will help us better understand the role of ECMO and ECPR in the treatment of patients with acute lung or heart failure.

show abstract

A Review of the Fundamental Principles and Evidence Base in the Use of Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Adult Patients

Cited by 169 publications

References 98 publications

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Extracorporeal membrane oxygenation for critically ill adults

Extracorporeal membrane oxygenation for critically ill adults

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