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Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies.

Tulman DB, Stawicki SP, Whitson BA, Gupta SC, Tripathi RS, Firstenberg MS, Hayes D, Xu X, Papadimos TJ - BMC Anesthesiol (2014)

Bottom Line: Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual.Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected.There are challenges that still must be overcome.

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Affiliation: Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA.

ABSTRACT

Background: Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected.

Discussion: Here we present a synopsis of the challenges, considerations, and potential controversies regarding veno-venous ECMO that will be of benefit to anesthesiologists, surgeons, and intensivists, especially those newly confronted with care of the ECMO patient. We outline a number of points related to ECMO, particularly regarding cannulation, pump/oxygenator design, anticoagulation, and intravascular fluid management of patients. We then address these challenges/considerations/controversies in the context of their potential future implications on clinical approaches to ECMO patients, focusing on the development and advancement of standardized ECMO clinical practices.

Summary: Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.

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Related in: MedlinePlus

Examples of VV femoral cannulization. (A) femoral-femoral connection; (B) femoral jugular connection.
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Figure 1: Examples of VV femoral cannulization. (A) femoral-femoral connection; (B) femoral jugular connection.

Mentions: VV ECMO requires only venous access. Usually the access is accomplished using any combinations of femoral vein(s) (FigureĀ 1), internal jugular vein(s) or subclavian vein(s). Ultrasound guidance in conjunction with the Seldinger technique may be helpful. VV ECMO can be administered with one cannula or two [25,26].


Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies.

Tulman DB, Stawicki SP, Whitson BA, Gupta SC, Tripathi RS, Firstenberg MS, Hayes D, Xu X, Papadimos TJ - BMC Anesthesiol (2014)

Examples of VV femoral cannulization. (A) femoral-femoral connection; (B) femoral jugular connection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126084&req=5

Figure 1: Examples of VV femoral cannulization. (A) femoral-femoral connection; (B) femoral jugular connection.
Mentions: VV ECMO requires only venous access. Usually the access is accomplished using any combinations of femoral vein(s) (FigureĀ 1), internal jugular vein(s) or subclavian vein(s). Ultrasound guidance in conjunction with the Seldinger technique may be helpful. VV ECMO can be administered with one cannula or two [25,26].

Bottom Line: Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual.Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected.There are challenges that still must be overcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA.

ABSTRACT

Background: Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected.

Discussion: Here we present a synopsis of the challenges, considerations, and potential controversies regarding veno-venous ECMO that will be of benefit to anesthesiologists, surgeons, and intensivists, especially those newly confronted with care of the ECMO patient. We outline a number of points related to ECMO, particularly regarding cannulation, pump/oxygenator design, anticoagulation, and intravascular fluid management of patients. We then address these challenges/considerations/controversies in the context of their potential future implications on clinical approaches to ECMO patients, focusing on the development and advancement of standardized ECMO clinical practices.

Summary: Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.

Show MeSH
Related in: MedlinePlus