Methods of extracorporeal oxygenation and C₂ removal primarily for lung support

Czech version

Authors: Stibor Bronislav; Schwameis Franz
Authors‘ workplace: ICU, Landesklinikum Baden bei Wien, Austria
Published in: Anest. intenziv. Med., 25, 2014, č. 2, s. 98-106
Category: Intensive Care Medicine - Review Article

Overview

In severe cases of respiratory failure it may be impossible to achieve adequate gas exchange while using protective settings of mechanical ventilation, which in turn may result in further lung damage. Cardiac bypass machines for extracorporeal membrane oxygenation (cardiac bypass) have been used in the past for rescue management of patients with critical hypoxaemia, however their use was limited to centres with cardiac surgery facilities and the complication rates were high.

New technology, primarily aimed at supporting the respiratory function, has been introduced to clinical practice in the recent years – ‘pulmonary’ extracorporeal membrane oxygenation (ECMO). Improved oxygenation and CO₂ elimination allows ventilator settings to be less aggressive and the term ‘ultra-protective mechanical ventilation’ has emerged. ECMO has become the default management of some conditions and in some groups of patients (such as COPD patients or lung transplant awaiting patients) it has allowed the patients to stay off mechanical ventilation. This article is aimed at the principles, indications and uses of ECMO.

Keywords:
protective mechanical ventilation – extracorporeal lung support – extracorporeal membrane oxygenation – CO₂ elimination – oxygenator – pump – ultra-protective mechanical ventilation – anticoagulation

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