Pumpless extracorporeal lung assist and adult respiratory distress syndrome

Reng, Michael; Philipp, Alois; Kaiser, Moritz; Pfeifer, Michael; Gruene, Stefan; Schoelmerich, Jeurgen

doi:10.1016/s0140-6736(00)02485-5

Cited by 104 publications

(54 citation statements)

References 5 publications

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“…Most studies in humans have described a significant rise in Pa,O 2 after implementation of iLA treatment [6][7][8][16][17][18]. The patients evaluated in the current study had a Pa,O 2 /FI,O 2 ratio of 69 mmHg before iLA treatment, which increased to 94 mmHg within 2 h (p,0.001).…”

Section: Effects On Oxygen Transportmentioning

confidence: 50%

“…Optimised technical design, especially the development of low-resistance oxygenators, made the use of pumpless devices in humans possible. Early clinical results in small series of patients were encouraging [5][6][7][8] and meanwhile interventional lung assist (iLA) has become commercially available. Prospective controlled trials, which are still lacking, have been demanded [9] and have commenced recently.…”

mentioning

confidence: 99%

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Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy

Müller¹,

Lubnow²,

Philipp³

et al. 2008

Eur Respir J

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Respiratory acidosis can become a serious problem during protective ventilation of severe lung failure. A pumpless arteriovenous interventional lung assist (iLA) for extracorporeal carbon dioxide removal has been used increasingly to control critical respiratory situations. The present study sought to evaluate the factors determining the efficacy of iLA and calculate its contribution to gas exchange.In a cohort of 96 patients with severe acute respiratory distress syndrome, haemodynamic parameters, oxygen consumption and carbon dioxide production as well as gas transfer through the iLA were analysed.The measurements demonstrated a significant dependency of blood flowviathe iLA device on cannula size (mean±sd1.59±0.52 L·min−1for 15 French (Fr), 1.94±0.35 L·min−1for 17 Fr, and 2.22 ±0.45 L·min−1for 19 Fr) and on mean arterial pressure. Oxygen transfer capacity averaged 41.7±20.8 mL·min−1, carbon dioxide removal was 148.0±63.4 mL·min−1. Within two hours of iLA treatment, arterial oxygen partial pressure/inspired oxygen fraction ratio increased significantly and a fast improvement in arterial carbon dioxide partial pressure and pH was observed.Interventional lung assist eliminates ∼50% of calculated total carbon dioxide production with rapid normalisation of respiratory acidosis. Despite limited contribution to oxygen transfer it may allow a more protective ventilation in severe respiratory failure.

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Section: Effects On Oxygen Transportmentioning

confidence: 50%

mentioning

confidence: 99%

Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy

Müller¹,

Lubnow²,

Philipp³

et al. 2008

Eur Respir J

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“…DECAPSMART is a classic example of pulmonary/renal support and has been used successfully in isolated instances [10,74]. This adaptation can also be extended to other ECCO2R devices and can also be used with AVCO2R [75]. …”

Section: Pulmonary/renal Support – Mostmentioning

confidence: 99%

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Kaushik

Wojewódzka-Żelezniakowicz

Cruz

et al. 2012

Blood Purif

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Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field.

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“…Der Einsatz der oben dargestellten Polymethylpentenmembran statt einer herkömmlichen mikroporösen Polypropylenmembran macht den Oxygenator Plasma-leakage-resistent, und das reduzierte Risiko einer Luftembolie erlaubt einen deutlich höheren Gasfluss mit einer verbesserten Kohlendioxidelimination.In einer ersten unkontrollierten Studie wurden 20 ARDS-Patienten (p a O 2 45,9± 7 mmHg bei F I O 2 1,0) mit dieser arteriovenösen pumpenlosen ECLA für 1-32 Tage behandelt.Der durchschnittliche Blutfluss der ECLA lag deutlich höher als in der anderen Studie bei 2,6±0,6 l/min entsprechend etwa 25% des HZV [19,28] …”

Section: Arteriovenöse Pumpenlose "Extracorporeal Lung Assist"unclassified

Extrakorporale Membranoxygenierung beim akuten Lungenversagen

et al. 2004

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After various observational studies demonstrated a benefit of extracorporeal membrane oxygenation (ECMO) in the therapy of severe acute respiratory distress syndrome (ARDS), ECMO now represents an important contribution for ARDS therapy using clinical algorithms despite a lack of positive controlled studies. In specialized centers patients with severe ARDS and imminent hypoxia despite intensive conventional therapy, are treated with ECMO using blood pumps and artificial membrane lungs (oxygenators) for extracorporeal lung assist. The development of new surface modifications, optimized oxygenators and miniaturized blood pumps should increase hemocompatibility and lead to simplified treatment as well as less complications. New oxygenators with significantly decreased blood resistance allow the clinical application of pumpless arteriovenous extracorporeal lung assist (ECLA). After these new developments indications for ECMO could be extended from use not only as ultimate ratio but to less severe ARDS to enable lung protective, less invasive mechanical ventilation.

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Pumpless extracorporeal lung assist and adult respiratory distress syndrome

Cited by 104 publications

References 5 publications

Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy

Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Extrakorporale Membranoxygenierung beim akuten Lungenversagen

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