Tuberc Respir Dis.  2015 Jul;78(3):149-155. 10.4046/trd.2015.78.3.149.

Update on the Extracorporeal Life Support

• Huh JW

• KMID: 2320636
• DOI: http://doi.org/10.4046/trd.2015.78.3.149

Abstract

Extracorporeal life support (ECLS) is a type of cardiopulmonary bypass. It is an artificial means of supplying oxygen and removing CO2 on behalf of damaged lungs while patients are recovering from underlying diseases. Recently, the use of ECLS is rapidly increasing as this machine becomes smaller, less invasive and easier to use. In addition, the improvement of clinicians' technique and outcome is increasing their application to patients with acute respiratory distress. In this regard, the purpose of this review is to introduce the physiological principles, risk factors, and advantages of ECLS, clinical rationale for using ECLS, ventilatory strategy during ECLS, which are still causing different opinions, the weaning from ECLS, and the use of anticoagulant.

Keyword

Respiratory Distress Syndrome, Adult; Extracorporeal Membrane Oxygenation

MeSH Terms

Cardiopulmonary Bypass
Extracorporeal Membrane Oxygenation
Humans
Lung
Oxygen
Respiratory Distress Syndrome, Adult
Risk Factors
Weaning
Oxygen

Reference

1. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Davies A, Jones D, Bailey M, Beca J, Bellomo R, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009; 302:1888–1895.

2. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009; 374:1351–1363.

3. Del Sorbo L, Cypel M, Fan E. Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med. 2014; 2:154–164.

4. Gattinoni L, Carlesso E, Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care. 2011; 15:243.

5. Cove ME, MacLaren G, Federspiel WJ, Kellum JA. Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care. 2012; 16:232.

6. Zimmermann M, Bein T, Arlt M, Philipp A, Rupprecht L, Mueller T, et al. Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care. 2009; 13:R10.

7. Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011; 37:1447–1457.

8. Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011; 306:1659–1668.

9. Pham T, Combes A, Roze H, Chevret S, Mercat A, Roch A, et al. Extracorporeal membrane oxygenation for pandemic influenza A (H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013; 187:276–285.

10. Bein T, Weber-Carstens S, Goldmann A, Muller T, Staudinger T, Brederlau J, et al. Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO₂ removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med. 2013; 39:847–856.

11. Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, et al. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009; 111:826–835.

12. Lachmann B. Open up the lung and keep the lung open. Intensive Care Med. 1992; 18:319–321.

13. Vieillard-Baron A, Jardin F. Right level of positive end-expiratory pressure in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2003; 167:1576.

14. Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001; 164:43–49.

15. Marini JJ. Spontaneously regulated vs. controlled ventilation of acute lung injury/acute respiratory distress syndrome. Curr Opin Crit Care. 2011; 17:24–29.

16. Braune S, Kienast S, Hadem J, Wiesner O, Wichmann D, Nierhaus A, et al. Safety of percutaneous dilatational tracheostomy in patients on extracorporeal lung support. Intensive Care Med. 2013; 39:1792–1799.

17. Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, et al. Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Ann Intensive Care. 2014; 4:15.

18. MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012; 38:210–220.

19. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011; 365:1905–1914.

20. Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012; 185:763–768.

21. Rehder KJ, Turner DA, Hartwig MG, Williford WL, Bonadonna D, Walczak RJ Jr, et al. Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation. Respir Care. 2013; 58:1291–1298.

22. Turner DA, Cheifetz IM, Rehder KJ, Williford WL, Bonadonna D, Banuelos SJ, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med. 2011; 39:2593–2598.

23. Hodgson CL, Fan E. A step up for extracorporeal membrane oxygenation: active rehabilitation. Respir Care. 2013; 58:1388–1390.

24. Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula-toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J. 2008; 54:606–611.

25. Foley DS, Pranikoff T, Younger JG, Swaniker F, Hemmila MR, Remenapp RA, et al. A review of 100 patients transported on extracorporeal life support. ASAIO J. 2002; 48:612–619.

26. Buck ML. Control of Coagulation during extracorporeal membrane oxygenation. J Pediatr Pharmacol Ther. 2005; 10:26–35.

27. Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014; 189:1374–1382.