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Extracorporeal membrane oxygenation for acute respiratory distress syndrome.

Aokage T, Palmér K, Ichiba S, Takeda S - J Intensive Care (2015)

Bottom Line: Extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy in patients with refractory severe respiratory failure or cardiac failure.ECMO can stabilize gas exchange and haemodynamic compromise, consequently preventing further hypoxic organ damage.ECMO transport may be an effective method of transferring patients with severe ARDS.

View Article: PubMed Central - PubMed

Affiliation: ECMO Centre Karolinska, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 17176 Stockholm, Sweden.

ABSTRACT
Extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy in patients with refractory severe respiratory failure or cardiac failure. Severe acute respiratory distress syndrome (ARDS) still has a high-mortality rate, but ECMO may be able to improve the outcome. Use of ECMO for respiratory failure has been increasing since 2009. Initiation of ECMO for adult ARDS should be considered when conventional therapy cannot maintain adequate oxygenation. ECMO can stabilize gas exchange and haemodynamic compromise, consequently preventing further hypoxic organ damage. ECMO is not a treatment for the underlying cause of ARDS. Because ARDS has multiple causes, the diagnosis should be investigated and treatment should be commenced during ECMO. Since ECMO is a complicated and high-risk therapy, adequate training in its performance and creation of a referring hospital network are essential. ECMO transport may be an effective method of transferring patients with severe ARDS.

No MeSH data available.


Related in: MedlinePlus

Vascular access and cannula position. Panel (A) shows the circulatory kinetics of VV ECMO with drainage from the right internal jugular vein (RIJV) and infusion to the femoral vein (FV). The oxygenated blood from the infusion cannula (red arrow) is mixed with the venous blood in the inferior vena cava (IVC) and right atrium (RA). The mixed blood (purple arrow) flows through the lungs to the arterial side. Panel (B) shows the circulatory kinetics of VA ECMO with drainage from the RIJV and infusion to the femoral artery. The venous blood (blue arrow) flows through the lungs to the upper body without oxygenating the blood if the lung function is poor. Panel (C) shows the correct position of the draining cannula tip for VV/VA ECMO with drainage from the RIJV and infusion to the femoral vein/artery as panels (A, B). The tip should be located in the upper or middle RA to drain blood with a lower O2 saturation from the superior vena cava (SVC). Panel (D) shows the tip locating the lower position than panel (C), where the blood from the IVC is mostly drained. Because the blood from the IVC contains more oxygen than that from the SVC, the O2 saturation of the drained blood becomes higher; consequently, the efficiency of oxygenation by ECMO is decreasing. A-Ao denotes ascending aorta, D-Ao descending aorta, RV right ventricle, and FA femoral artery.
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Fig1: Vascular access and cannula position. Panel (A) shows the circulatory kinetics of VV ECMO with drainage from the right internal jugular vein (RIJV) and infusion to the femoral vein (FV). The oxygenated blood from the infusion cannula (red arrow) is mixed with the venous blood in the inferior vena cava (IVC) and right atrium (RA). The mixed blood (purple arrow) flows through the lungs to the arterial side. Panel (B) shows the circulatory kinetics of VA ECMO with drainage from the RIJV and infusion to the femoral artery. The venous blood (blue arrow) flows through the lungs to the upper body without oxygenating the blood if the lung function is poor. Panel (C) shows the correct position of the draining cannula tip for VV/VA ECMO with drainage from the RIJV and infusion to the femoral vein/artery as panels (A, B). The tip should be located in the upper or middle RA to drain blood with a lower O2 saturation from the superior vena cava (SVC). Panel (D) shows the tip locating the lower position than panel (C), where the blood from the IVC is mostly drained. Because the blood from the IVC contains more oxygen than that from the SVC, the O2 saturation of the drained blood becomes higher; consequently, the efficiency of oxygenation by ECMO is decreasing. A-Ao denotes ascending aorta, D-Ao descending aorta, RV right ventricle, and FA femoral artery.

Mentions: ECMO is a form of mechanical assist therapy that employs an extracorporeal blood circuit including an oxygenator and a pump. To perform standard respiratory ECMO, two vascular accesses are established, one for removal of venous blood and the other for infusion of oxygenated blood. Blood is drained from a major vein and pumped through a circuit that includes an oxygenator, which oxygenates the blood and removes carbon dioxide (CO2), after which the oxygenated blood is returned via the other cannula. When blood is returned to the venous side of the circulation, the procedure is known as veno-venous ECMO (VV ECMO), which provides gas exchange but cannot give cardiac support (Figure 1A). When blood is returned to the arterial side of the circulation, this is called veno-arterial ECMO (VA ECMO), and it can be employed for both gas exchange and cardiac support (Figure 1B). If the patient’s circulation is stable without high-dose inotrope therapy and echocardiography does not show right ventricular or left ventricular failure, VV ECMO should be selected. VA ECMO is associated with the potential risk of major limb vessel occlusion by the arterial cannula, as well as arterial embolism and refractory cannula site bleeding. The common reasons for selecting VA ECMO in ARDS patients are pulmonary hypertension, cardiac dysfunction associated with sepsis, and arrhythmia.Figure 1


Extracorporeal membrane oxygenation for acute respiratory distress syndrome.

Aokage T, Palmér K, Ichiba S, Takeda S - J Intensive Care (2015)

Vascular access and cannula position. Panel (A) shows the circulatory kinetics of VV ECMO with drainage from the right internal jugular vein (RIJV) and infusion to the femoral vein (FV). The oxygenated blood from the infusion cannula (red arrow) is mixed with the venous blood in the inferior vena cava (IVC) and right atrium (RA). The mixed blood (purple arrow) flows through the lungs to the arterial side. Panel (B) shows the circulatory kinetics of VA ECMO with drainage from the RIJV and infusion to the femoral artery. The venous blood (blue arrow) flows through the lungs to the upper body without oxygenating the blood if the lung function is poor. Panel (C) shows the correct position of the draining cannula tip for VV/VA ECMO with drainage from the RIJV and infusion to the femoral vein/artery as panels (A, B). The tip should be located in the upper or middle RA to drain blood with a lower O2 saturation from the superior vena cava (SVC). Panel (D) shows the tip locating the lower position than panel (C), where the blood from the IVC is mostly drained. Because the blood from the IVC contains more oxygen than that from the SVC, the O2 saturation of the drained blood becomes higher; consequently, the efficiency of oxygenation by ECMO is decreasing. A-Ao denotes ascending aorta, D-Ao descending aorta, RV right ventricle, and FA femoral artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940971&req=5

Fig1: Vascular access and cannula position. Panel (A) shows the circulatory kinetics of VV ECMO with drainage from the right internal jugular vein (RIJV) and infusion to the femoral vein (FV). The oxygenated blood from the infusion cannula (red arrow) is mixed with the venous blood in the inferior vena cava (IVC) and right atrium (RA). The mixed blood (purple arrow) flows through the lungs to the arterial side. Panel (B) shows the circulatory kinetics of VA ECMO with drainage from the RIJV and infusion to the femoral artery. The venous blood (blue arrow) flows through the lungs to the upper body without oxygenating the blood if the lung function is poor. Panel (C) shows the correct position of the draining cannula tip for VV/VA ECMO with drainage from the RIJV and infusion to the femoral vein/artery as panels (A, B). The tip should be located in the upper or middle RA to drain blood with a lower O2 saturation from the superior vena cava (SVC). Panel (D) shows the tip locating the lower position than panel (C), where the blood from the IVC is mostly drained. Because the blood from the IVC contains more oxygen than that from the SVC, the O2 saturation of the drained blood becomes higher; consequently, the efficiency of oxygenation by ECMO is decreasing. A-Ao denotes ascending aorta, D-Ao descending aorta, RV right ventricle, and FA femoral artery.
Mentions: ECMO is a form of mechanical assist therapy that employs an extracorporeal blood circuit including an oxygenator and a pump. To perform standard respiratory ECMO, two vascular accesses are established, one for removal of venous blood and the other for infusion of oxygenated blood. Blood is drained from a major vein and pumped through a circuit that includes an oxygenator, which oxygenates the blood and removes carbon dioxide (CO2), after which the oxygenated blood is returned via the other cannula. When blood is returned to the venous side of the circulation, the procedure is known as veno-venous ECMO (VV ECMO), which provides gas exchange but cannot give cardiac support (Figure 1A). When blood is returned to the arterial side of the circulation, this is called veno-arterial ECMO (VA ECMO), and it can be employed for both gas exchange and cardiac support (Figure 1B). If the patient’s circulation is stable without high-dose inotrope therapy and echocardiography does not show right ventricular or left ventricular failure, VV ECMO should be selected. VA ECMO is associated with the potential risk of major limb vessel occlusion by the arterial cannula, as well as arterial embolism and refractory cannula site bleeding. The common reasons for selecting VA ECMO in ARDS patients are pulmonary hypertension, cardiac dysfunction associated with sepsis, and arrhythmia.Figure 1

Bottom Line: Extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy in patients with refractory severe respiratory failure or cardiac failure.ECMO can stabilize gas exchange and haemodynamic compromise, consequently preventing further hypoxic organ damage.ECMO transport may be an effective method of transferring patients with severe ARDS.

View Article: PubMed Central - PubMed

Affiliation: ECMO Centre Karolinska, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 17176 Stockholm, Sweden.

ABSTRACT
Extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy in patients with refractory severe respiratory failure or cardiac failure. Severe acute respiratory distress syndrome (ARDS) still has a high-mortality rate, but ECMO may be able to improve the outcome. Use of ECMO for respiratory failure has been increasing since 2009. Initiation of ECMO for adult ARDS should be considered when conventional therapy cannot maintain adequate oxygenation. ECMO can stabilize gas exchange and haemodynamic compromise, consequently preventing further hypoxic organ damage. ECMO is not a treatment for the underlying cause of ARDS. Because ARDS has multiple causes, the diagnosis should be investigated and treatment should be commenced during ECMO. Since ECMO is a complicated and high-risk therapy, adequate training in its performance and creation of a referring hospital network are essential. ECMO transport may be an effective method of transferring patients with severe ARDS.

No MeSH data available.


Related in: MedlinePlus