VV-ECMO in Respiratory Insufficiency

Abstract

Extracorporeal membrane oxygenation (ECMO) has advanced significantly in the last few decades. Although not FDA-approved in the United States for respiratory insufficiency, it is widely used to support cardiac and pulmonary function via Venoarterial (VA) and Venovenous (VV) ECMO, respectively. In the patient with worsening respiratory failure VV-ECMO is considered a salvaging therapy that gives patients’ lungs time to heal or as a bridge to lung transplant. Clinicians use tools like the Murray score to initiate a referral for VV-ECMO using indices like oxygen requirement, pulmonary compliance, and bilateral opacities. Early referral for VV-ECMO within 7 days of intubation has shown better results. Important factors that are considered in ECMO candidacy are patients’ age, comorbid conditions, and chronic conditions that would affect patients’ overall longevity. Extracorporeal life support organization (ELSO) gets data from ECMO centers worldwide and has general recommendations for centers guiding treatment and management. During the COVID pandemic, there was a huge surge in acute respiratory distress syndrome (ARDS) and rampant use of VV-ECMO for COVID-ARDS. Data from various centers have helped us understand the appropriate use of VV-ECMO for ARDS and other causes of hypoxic and hypercapnic respiratory failure. Early referral and careful screening for the patient for ECMO are of paramount importance for a better outcome.