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.

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.

scholarly journals Ad-hoc Assembly of Lean Extracorporeal Membrane Oxygenation Systems for COVID-19

2020 ◽  
Author(s):  
Patrick Hunziker ◽  
Urs Zenklusen
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Ad Hoc ◽  
Life Support ◽  
Venous Access ◽  
Treatment Modalities ◽  
Worst Case ◽  
Membrane Oxygenation ◽  
Blood Pumps ◽  
Vv Ecmo

AbstractBackgroundThe COVID-19 epidemic is overwhelming intensive care units with bilateral pneumonia patients requiring respiratory assistance. Bottlenecks in availability of ventilators and extracorporeal membrane oxygenation may contribute to mortality, implying ethically difficult rationing decisions. It is unclear if accelerated equipment production will meet demand, calling for fallback solutions for life support in worst-case scenarios.MethodsVeno-venous extracorporeal gas exchange (VV-ECMO) can provide vital support in bilateral lung failure. VV-ECMO essentially comprises large flow venous accesses, membrane gas exchange, and a blood pump. As thousands of FDA and CE certified Impella blood pumps and consoles are distributed globally for cardiac support, we explored ad-hoc assembly of lean ECMO systems by embedding Impella pumps coaxially in tubes in combination with standard gas exchangers.ResultsAd-hoc integration of Impella blood pumps with gas exchange modules, standard cannulas for large bore venous access, regular ECMO tubing, Y-pieces and connectors led to lean ECMO systems with stable performance over several days. Oxygenation of 2.5-5 L of blood/minute is realistic. Benefit/risk analysis appears favorable if a patient requires respiratory support but cannot be supported because of lack of ventilators or unavailability of a required ECMO system.ConclusionAd-hoc assembly of veno-venous ECMOs using Impella pumps is feasible and results in stable blood flow across gas exchange modules. However, such off-label use of the devices calls for specific ethical and regulatory considerations prior to their use as last resort in patients for whom no other treatment modalities are available.

scholarly journals Recovery from respiratory failure after 49-day extracorporeal membrane oxygenation support in a critically ill patient with COVID-19: case report

2020 ◽  
Author(s):  
Fengwei Guo ◽  
Chao Deng ◽  
Tao Shi ◽  
Yang Yan
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Life Support ◽  
Critically Ill Patient ◽  
Hypoxemic Respiratory Failure ◽  
Plasma Therapy ◽  
Form Of Life ◽  
Membrane Oxygenation ◽  
Life Threatening

Abstract Background Respiratory failure is a life-threatening complication of coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) in COVID-19 might offer promise based on our clinical experience. However, few critically ill cases with COVID-19 have been weaned off ECMO. Case summary A 66-year-old Chinese woman presented with fever (38.9°C), cough, dyspnoea, and headache. She had lymphopenia (0.72 × 109/L) and computed tomography findings of ground-glass opacities. Subsequently, she was confirmed to have respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. She was intubated after transfer to the intensive care unit due to respiratory failure and heart failure. However, her condition continued to deteriorate rapidly. Veno-veno ECMO was undertaken for respiratory and cardiac support due to refractory hypoxemic respiratory failure and bradyarrhythmia (45 b.p.m.). During hospitalization, she was also administered anti-viral treatment, convalescent plasma therapy, and continuous renal replacement therapy. She was maintained on ECMO before she had fully recovered from the condition that necessitated ECMO use and had a negative test for the nucleic acids of SARS-CoV-2 twice. Forty-nine days later, this patient was weaned from ECMO. At the most recent follow-up visit (3 months after weaning from ECMO), she received respiratory and cardiac rehabilitation and did not complain of any discomfort. Discussion As far as we know, the longest duration of ECMO treatment in this critical case with COVID-19 is supportive of ECMO as the most aggressive form of life support and the last line of defence during the COVID-19 epidemic.

scholarly journals EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) – IN THE TREATMENT OF SEVERE, LIFE-THREATENING RESPIRATORY FAILURE

2019 ◽  
Vol 72 (9) ◽  
pp. 1822-1828
Author(s):  
Krystian Ślusarz ◽  
Paulina Kurdyś ◽  
Paul Armatowicz ◽  
Piotr Knapik ◽  
Ewa Trejnowska
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Invasive Mechanical Ventilation ◽  
Lung Damage ◽  
Respiratory Support ◽  
Membrane Oxygenation ◽  
Clinical Complications ◽  
Life Threatening

Extracorporeal membrane oxygenation (ECMO) is a technique involving oxygenation of blood and elimination of carbon dioxide in patients with life-threatening, but potentially reversible conditions. Thanks to the modification of extracorporeal circulation used during cardiac surgeries, this technique can be used in intensive care units. Venovenous ECMO is used as a respiratory support, while venoarterial ECMO as a cardiac and/or respiratory support. ECMO does not cure the heart and/or lungs, but it gives the patient a chance to survive a period when these organs are inefficient. In addition, extracorporeal membrane oxygenation reduces or eliminates the risk of lung damage associated with invasive mechanical ventilation in patients with severe ARDS (acute respiratory distress syndrome). ECMO is a very invasive therapy, therefore it should only be used in patients with extremely severe respiratory failure, who failed to respond to conventional therapies. According to the Extracorporeal Life Support Organization (ELSO) Guidelines, inclusion criteria are: PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours. Proper ECMO management requires advanced medical care. This article discusses the history of ECMO development, clinical indications, contraindications, clinical complications and treatment outcomes.

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