Physiology of Gas Exchange During ECMO for Respiratory Failure

2016 ◽  
Vol 32 (4) ◽  
pp. 243-248 ◽  
Author(s):  
Robert H. Bartlett
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Venous Blood ◽  
Arterial Oxygenation ◽  
Membrane Lung ◽  
Membrane Oxygenation

Management of gas exchange using extracorporeal membrane oxygenation (ECMO) in respiratory failure is very different than management when the patient is dependent on mechanical ventilation. All the gas exchange occurs in the membrane lung, and the arterial oxygenation is the result of mixing the ECMO blood with the native venous blood. To manage patients on ECMO, it is essential to understand the physiology described in this essay.

Computational Analysis of a Wearable Artificial Pump Lung Device in Terms of Rotor/Stator Interactions

2009 ◽  
Author(s):  
M. Ertan Taskin ◽  
Tao Zhang ◽  
Bartley P. Griffith ◽  
Zhongjun J. Wu
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Disease ◽  
Computational Analysis ◽  
Respiratory Support ◽  
Membrane Oxygenation ◽  
Current Therapies

Lung disease is America’s third largest killer, and responsible for one in seven deaths [1]. Most lung disease is chronic, and respiratory support is essential. Current therapies for the respiratory failure include mechanical ventilation and bed-side extracorporeal membrane oxygenation (ECMO) devices which closely simulate the physiological gas exchange of the natural lung.

Method of Pulmonary and Membrane Lung Gas Exchange Measurement during Extracorporeal Membrane Oxygenation

1986 ◽  
Vol 32 (1) ◽  
pp. 525-529
Author(s):  
ROBERT E. CILLEY ◽  
JOHN R. WESLEY ◽  
JOSEPH B. ZWISCHENBERGER ◽  
JOHN M. TOOMASIAN ◽  
ROBERT H. BARTIETT
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Lung ◽  
Membrane Oxygenation ◽  
Exchange Measurement

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 22-29 ◽  
Author(s):  
Lars Falk ◽  
Marko Sallisalmi ◽  
Jonas Andersson Lindholm ◽  
Mattias Lindfors ◽  
Björn Frenckner ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Venous Blood ◽  
Vena Cava ◽  
Upper Body ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Hemodynamic State

Venoarterial extracorporeal membrane oxygenation, indicated for severe cardio-respiratory failure, may result in anatomic regional differences in oxygen saturation. This depends on cannulation, hemodynamic state, and severity of respiratory failure. Differential hypoxemia, often discrete, may cause clinical problems in peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation, when the upper body is perfused with low saturated blood from the heart and the lower body with well-oxygenated extracorporeal membrane oxygenation blood. The key is to diagnose and manage fulminant differential hypoxemia, that is, a state that may develop where the upper body is deprived of oxygen. We summarize physiology, assessment of diagnosis, and management of fulminant differential hypoxemia during venoarterial extracorporeal membrane oxygenation. A possible solution is implantation of an additional jugular venous return cannula. In this article, we propose an even better solution, to drain the venous blood from the superior vena cava. Drainage from the superior vena cava provides superiority to venovenoarterial configuration in terms of physiological rationale, efficiency, safety, and simplicity in clinical circuit design.

scholarly journals Method of Pulmonary and Membrane Lung Gas Exchange Measurement during Extracorporeal Membrane Oxygenation

1986 ◽  
Vol 32 (1) ◽  
pp. 525-529 ◽  
Author(s):  
ROBERT E. CILLEY ◽  
JOHN R. WESLEY ◽  
JOSEPH B. ZWISCHENBERGER ◽  
JOHN M. TOOMASIAN ◽  
ROBERT H. BARTIETT
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Lung ◽  
Membrane Oxygenation ◽  
Exchange Measurement

scholarly journals Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Zhongheng Zhang ◽  
Wan-Jie Gu ◽  
Kun Chen ◽  
Hongying Ni
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Large Body ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Severe Respiratory Failure ◽  
Membrane Oxygenation ◽  
Number Of Patients ◽  
Protective Ventilation Strategy

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

scholarly journals Physiological Basis of Extracorporeal Membrane Oxygenation and Extracorporeal Carbon Dioxide Removal in Respiratory Failure

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 225
Author(s):  
Barbara Ficial ◽  
Francesco Vasques ◽  
Joe Zhang ◽  
Stephen Whebell ◽  
Michael Slattery ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Respiratory Failure ◽  
Lung Function ◽  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Co2 Removal ◽  
Physiological Basis ◽  
Membrane Oxygenation ◽  
Native Lung

Extracorporeal life support (ECLS) for severe respiratory failure has seen an exponential growth in recent years. Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO2 removal (ECCO2R) represent two modalities that can provide full or partial support of the native lung function, when mechanical ventilation is either unable to achieve sufficient gas exchange to meet metabolic demands, or when its intensity is considered injurious. While the use of ECMO has defined indications in clinical practice, ECCO2R remains a promising technique, whose safety and efficacy are still being investigated. Understanding the physiological principles of gas exchange during respiratory ECLS and the interactions with native gas exchange and haemodynamics are essential for the safe applications of these techniques in clinical practice. In this review, we will present the physiological basis of gas exchange in ECMO and ECCO2R, and the implications of their interaction with native lung function. We will also discuss the rationale for their use in clinical practice, their current advances, and future directions.

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