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Extracorporeal membrane oxygenation for severe acute respiratory failure.
Crit Care. 2000; 4(3):156-68.CC

Abstract

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass techniques and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The initial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over conventional treatment; survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered and will need evaluation by a future RCT.

Authors+Show Affiliations

Klinik für Anästhesiologie und operative Intensivmedizin, Charité, Campus Virchow-Klinikum, Berlin, Germany. klaus.lewandowski@charite.de

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11094500

Citation

Lewandowski, K. "Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure." Critical Care (London, England), vol. 4, no. 3, 2000, pp. 156-68.
Lewandowski K. Extracorporeal membrane oxygenation for severe acute respiratory failure. Crit Care. 2000;4(3):156-68.
Lewandowski, K. (2000). Extracorporeal membrane oxygenation for severe acute respiratory failure. Critical Care (London, England), 4(3), 156-68.
Lewandowski K. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure. Crit Care. 2000;4(3):156-68. PubMed PMID: 11094500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal membrane oxygenation for severe acute respiratory failure. A1 - Lewandowski,K, Y1 - 2000/04/12/ PY - 1999/07/28/received PY - 2000/03/13/revised PY - 2000/03/16/accepted PY - 2000/11/30/pubmed PY - 2001/3/7/medline PY - 2000/11/30/entrez SP - 156 EP - 68 JF - Critical care (London, England) JO - Crit Care VL - 4 IS - 3 N2 - Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass techniques and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The initial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over conventional treatment; survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered and will need evaluation by a future RCT. SN - 1364-8535 UR - https://www.unboundmedicine.com/medline/citation/11094500/Extracorporeal_membrane_oxygenation_for_severe_acute_respiratory_failure_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc689 DB - PRIME DP - Unbound Medicine ER -