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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

Changes of O2supplied by ECMO. Oxygen supplied by ECMO (VO2 ECMO) is shown in an adult ARDS patient with H1N1 influenza. The amount of oxygen supplied decreases after the 30th day, indicating recovery of lung function. (Reproduced from Ref. [9]). VO2 ECMO is calculated as follows: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is extracorporeal circuit flow, outSaO2 is the saturation of arterialized blood in the returning circuit, inSvO2 is the venous blood saturation in the draining circuit, and Hb is the haemoglobin. The coefficient 1.39 (mlO2/gHb) denotes the O2 content (ml) per 1 g of haemoglobin.
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Fig2: Changes of O2supplied by ECMO. Oxygen supplied by ECMO (VO2 ECMO) is shown in an adult ARDS patient with H1N1 influenza. The amount of oxygen supplied decreases after the 30th day, indicating recovery of lung function. (Reproduced from Ref. [9]). VO2 ECMO is calculated as follows: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is extracorporeal circuit flow, outSaO2 is the saturation of arterialized blood in the returning circuit, inSvO2 is the venous blood saturation in the draining circuit, and Hb is the haemoglobin. The coefficient 1.39 (mlO2/gHb) denotes the O2 content (ml) per 1 g of haemoglobin.

Mentions: In addition, we often want to know the amount of O2 supplied by ECMO. If lung function is very poor, then O2 consumption corresponds to the amount of O2 supplied by ECMO, which is determined as the difference between returning blood O2 content and draining blood O2 content multiplied by the ECMO flow rate. Thus, oxygen supply is calculated by the following formulae: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is the extracorporeal circuit flow rate, outSaO2 is the saturation of arterialized blood in the returning circuit (always 1), and inSvO2 is the saturation of venous blood in the draining circuit [9]. As pulmonary oxygenation improves, the amount of O2 supplied by ECMO decreases, which means that monitoring O2 supplied via ECMO can be used to assess the process of pulmonary recovery (Figure 2) [9,10]. The formulae also indicate that the efficiency of oxygenation depends on the saturation of venous blood in the draining cannula.Figure 2


Extracorporeal membrane oxygenation for acute respiratory distress syndrome.

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

Changes of O2supplied by ECMO. Oxygen supplied by ECMO (VO2 ECMO) is shown in an adult ARDS patient with H1N1 influenza. The amount of oxygen supplied decreases after the 30th day, indicating recovery of lung function. (Reproduced from Ref. [9]). VO2 ECMO is calculated as follows: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is extracorporeal circuit flow, outSaO2 is the saturation of arterialized blood in the returning circuit, inSvO2 is the venous blood saturation in the draining circuit, and Hb is the haemoglobin. The coefficient 1.39 (mlO2/gHb) denotes the O2 content (ml) per 1 g of haemoglobin.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Changes of O2supplied by ECMO. Oxygen supplied by ECMO (VO2 ECMO) is shown in an adult ARDS patient with H1N1 influenza. The amount of oxygen supplied decreases after the 30th day, indicating recovery of lung function. (Reproduced from Ref. [9]). VO2 ECMO is calculated as follows: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is extracorporeal circuit flow, outSaO2 is the saturation of arterialized blood in the returning circuit, inSvO2 is the venous blood saturation in the draining circuit, and Hb is the haemoglobin. The coefficient 1.39 (mlO2/gHb) denotes the O2 content (ml) per 1 g of haemoglobin.
Mentions: In addition, we often want to know the amount of O2 supplied by ECMO. If lung function is very poor, then O2 consumption corresponds to the amount of O2 supplied by ECMO, which is determined as the difference between returning blood O2 content and draining blood O2 content multiplied by the ECMO flow rate. Thus, oxygen supply is calculated by the following formulae: ECC [l/min] × 1.39 [mlO2/gHb] × Hb [g/dl] × 10 × (outSaO2 − inSvO2), where ECC is the extracorporeal circuit flow rate, outSaO2 is the saturation of arterialized blood in the returning circuit (always 1), and inSvO2 is the saturation of venous blood in the draining circuit [9]. As pulmonary oxygenation improves, the amount of O2 supplied by ECMO decreases, which means that monitoring O2 supplied via ECMO can be used to assess the process of pulmonary recovery (Figure 2) [9,10]. The formulae also indicate that the efficiency of oxygenation depends on the saturation of venous blood in the draining cannula.Figure 2

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