A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure
Open Access
- 17 December 2009
- journal article
- research article
- Published by Springer Nature in Critical Care
- Vol. 13 (6) , R205
- https://doi.org/10.1186/cc8213
Abstract
Introduction: Mortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments. Methods: Efficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure. Results: A rapid increase of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) from 64 (48 to 86) mmHg to 120 (84 to 171) mmHg and a decrease of PaCO2 from 63 (50 to 80) mmHg to 33 (29 to 39) mmHg were observed after start of the extracorporeal support (P < 0.001). Gas exchange capacity of the device averaged 155 (116 to 182) mL/min for oxygen and 210 (164 to 251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401 to 570) mL to 336 (292 to 404) mL (P < 0.001) and of peak inspiratory pressure from 36 (32 to 40) cmH2O to 31 (28 to 35) cmH2O (P < 0.001). Transfusion requirements averaged 0.8 (0.4 to 1.8) units of red blood cells per day. Sixty-two percent of patients were weaned from the extracorporeal system, and 45% survived to discharge. Conclusions: Veno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure.Keywords
This publication has 31 references indexed in Scilit:
- Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trialThe Lancet, 2009
- Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?American Journal of Respiratory and Critical Care Medicine, 2009
- Blood transfusion requirements and independent predictors of increased transfusion requirements among adult patients on extracorporeal membrane oxygenation – a single centre experienceVox Sanguinis, 2008
- Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacyEuropean Respiratory Journal, 2008
- Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*Critical Care Medicine, 2008
- Extracorporeal Life Support for Severe Acute Respiratory Distress Syndrome in AdultsAnnals of Surgery, 2004
- The CRIT Study: Anemia and blood transfusion in the critically ill—Current clinical practice in the United States*Critical Care Medicine, 2004
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeNew England Journal of Medicine, 2000
- Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapyTransfusion, 1996
- Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective studyJAMA, 1979