Venovenous extracorporeal membrane oxygenation in adults: practical aspects of circuits, cannulae, and procedures

Autor: Timothy W Willcox, Alastair McGeorge, David Sidebotham, Nathan Ibbott, Sara Jane Allen
Rok vydání: 2012
Předmět:
Zdroj: Journal of cardiothoracic and vascular anesthesia. 26(5)
ISSN: 1532-8422
Popis: NTEREST IN extracorporeal membrane oxygenation (ECMO) for treating severe respiratory failure in adults has increased substantially in the last 5 years. There are several reasons for this increase. The first reason is the publication of the CESAR study in 2009, which showed improved survival in adults with severe acute respiratory distress syndrome (ARDS) randomized to consideration of ECMO compared with patients treated conventionally.1 Second is the H1N1 influenza pandemic of 2009 and 2010, which resulted in a substantial increase in the use of ECMO for treating severe respiratory failure. 2 The outcome from ECMO in this group of patients was excellent, with reported survival rates of 68% to 77%. 3-5 The third factor has been improvements in the equipment used for ECMO; in particular, the introduction of polymethylpentene (PMP) oxygenators, second-generation centrifugal pumps, and cannulae specifically designed for ECMO. Finally, ECMO increasingly is being used for patients undergoing surgical correction of critical airway obstruction (eg, tracheal papilloma).6,7 There are 2 basic forms of ECMO: venoarterial (VA) and venovenous (VV). VA ECMO supports the lungs and the heart (left and right ventricles), whereas VV supports the lungs only. In adults, VA ECMO is used for treating acute cardiac and cardiorespiratory failure. For acute cardiac failure, ECMO may be used instead of a ventricular assist device (VAD), as a bridging technique either to recovery or to a long-term VAD. Historically, VA ECMO also was used for treating respiratory failure in adults 8 and is still used commonly for treating neonatal respiratory failure. 2 However, VV ECMO is now the preferred mode of extracorporeal support for adults with ARDS because it avoids 2 important disadvantages associated with VA ECMO: the need for arterial cannulation and upper-body hypoxemia. Upper-body hypoxemia occurs in patients with respiratory failure but good cardiac function who are supported with peripheral VA ECMO in which the arterial cannula is placed in the femoral artery. Oxygenated blood from the ECMO circuit perfuses the lower body, but deoxygenated blood, passing through the nonfunctioning lungs and ejected from the left ventricle, perfuses the upper body (coronary arteries and cerebral circulation).
Databáze: OpenAIRE
Externí odkaz: