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02.11.2020 | Review

Extracorporeal life support for adults with acute respiratory distress syndrome

verfasst von: Alain Combes, Matthieu Schmidt, Carol L. Hodgson, Eddy Fan, Niall D. Ferguson, John F. Fraser, Samir Jaber, Antonio Pesenti, Marco Ranieri, Kathryn Rowan, Kiran Shekar, Arthur S. Slutsky, Daniel Brodie

Erschienen in: Intensive Care Medicine | Ausgabe 12/2020

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Abstract

Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO₂R) uses lower blood flow rates through smaller cannulae and provides substantial CO₂ elimination (~ 20–70% of total CO₂ production), albeit with marginal improvement in oxygenation. The rationale for using ECCO₂R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO₂R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.

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Titel: Extracorporeal life support for adults with acute respiratory distress syndrome
verfasst von: Alain Combes
Matthieu Schmidt
Carol L. Hodgson
Eddy Fan
Niall D. Ferguson
John F. Fraser
Samir Jaber
Antonio Pesenti
Marco Ranieri
Kathryn Rowan
Kiran Shekar
Arthur S. Slutsky
Daniel Brodie
Publikationsdatum: 02.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06290-1

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Extracorporeal life support for adults with acute respiratory distress syndrome

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