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Semin Respir Crit Care Med 2019; 40(01): 114-128
DOI: 10.1055/s-0039-1685191
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Extracorporeal Strategies in Acute Respiratory Distress Syndrome

Yiorgos Alexandros Cavayas
1   Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
2   Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada
,
Aneesh Thakore
1   Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
,
Eddy Fan
1   Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations Funding Dr. Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr. Fan reports personal fees from Abbott, ALung Technologies, and MC3 Cardiopulmonary outside this work.
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Publication History

Publication Date:
06 May 2019 (online)

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Abstract

Despite the breadth of life-sustaining interventions available, mortality in patients with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation of the potential iatrogenic injury associated with the use of mechanical ventilation has led clinicians and researchers to seek alternatives. Extracorporeal life support (ECLS) may be used to rescue patients with severely impaired gas exchange and provide time for injured lungs to recover while treating the underlying disease. In patients with ARDS, venovenous (VV) ECLS is commonly used, where venous blood is drained into a circuit that passes through a membrane lung, which provides gas exchange, and then returned to the venous system. VV-ECLS can be configured as a system that uses higher blood flows with extracorporeal membrane oxygenation (VV-ECMO) or as one that uses lower blood flows for extracorporeal carbon dioxide removal (VV-ECCO2R). Recent studies support the use of VV-ECMO in patients with severe ARDS who present with refractory gas exchange despite the use of lung-protective mechanical ventilation, positive end-expiratory pressure optimization, neuromuscular blockade, and prone positioning. The optimal management of patients during ECLS (i.e., anticoagulation, transfusions, mechanical ventilation) and the role of ECCO2R in the management of ARDS remain to be determined.

Keywords

extracorporeal membrane oxygenation - extracorporeal life support - ventilator-induced lung injury - acute respiratory distress syndrome
 

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