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Abstract

Extracorporeal membrane oxygenatioon (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass technique and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The initial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over convential treatment, survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered and will need evaluation by a future RCT.Keywords: acute respiratory distress syndrome, adults, children, complications, extracorporeal membrane oxygenation, follow up, history, lung protective mechanical ventilation, mortality rates, technology The electronic version of this article can be found online at http://ccforum.com/content/4/3/156 © Current Science Ltd ARDS = acute respiratory distress syndrome; ECCO 2 -R = extracorporeal carbon dioxide removal; ECMO = extracorporeal membrane oxygenation; LFPPV = low-frequency positive-pressure ventilation; NO = nitric oxide; PEEP = positive end-expiratory pressure; PPHN = persistent pulmonary hypertension; RCT = randomized controlled trial; V T = tidal volume.

Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012

“…1 The first multicenter National Institutes of Health (NIH)-sponsored ECMO clinical trial occurred in 1975 and randomized adults to 1 week of venoarterial ECMO or mechanical ventilator support. Equally high mortality rates were reported in both arms, but ECMO had greater than 90% mortality and no clinical benefit despite higher cost and greater resource use.…”

Early measurement of IL-10 predicts the outcomes of patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation

“…Extracorporeal membrane oxygenation (ECMO) is an option for treating ARDS associated hypoxemia that is refractory to conventional ventilation 3, 4 ; however, the beneficial role of ECMO in ARDS remain highly controversial 5, 6 . Therefore, identification of prognostic factors is a pivotal issue for appropriate use of this intensive care resource.…”

Extracorporeal Respiratory Support With a Miniature Integrated Pediatric Pump‐Lung Device in an Acute Ovine Respiratory Failure Model

“…While oxygenation failure secondary to diseases such as acute respiratory distress syndrome (ARDS) is devastating, many deaths are secondary to CO 2 retention and respiratory acidosis in chronic obstructive pulmonary disease [15]. Current management of acute respiratory failure includes mechanical ventilation and ECMO combined with medical management.…”