Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.

"Awake" extracorporeal membrane oxygenation (ECMO): Pathophysiology, technical considerations, and clinical pioneering / T. Langer, A. Santini, N. Bottino, S. Crotti, A.I. Batchinsky, A. Pesenti, L. Gattinoni. - In: CRITICAL CARE. - ISSN 1364-8535. - 20:1(2016), pp. 150.1-150.10.

"Awake" extracorporeal membrane oxygenation (ECMO): Pathophysiology, technical considerations, and clinical pioneering

T. Langer;A. Pesenti;L. Gattinoni
2016

Abstract

Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.
respiratory-distress-syndrome; acute lung injury; invasive mechanical ventilation; carbon-dioxide removal; pressure support ventilation; CO2 removal; life-support; gas-exchange; noninvasive ventilation; active rehabilitation
Settore MED/41 - Anestesiologia
CRITICAL CARE
http://ccforum.com/content/17
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/421627
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