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Venovenous extracorporeal membrane oxygenation for acute lung failure in adults.
J Heart Lung Transplant. 2012 Jan; 31(1):9-15.JH

Abstract

BACKGROUND

Acute lung failure (ALF) is an increasing problem that can be treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). This report summarizes prospectively collected data of an institutional experience with vv-ECMO.

METHODS

From January 2007 to December 2010, 176 patients (mean age, 48 ± 16; range, 14-78 years) with ALF refractory to conventional therapy were supported with vv-ECMO. The general indication for vv-ECMO was a partial oxygen pressure/fraction of inspired oxygen (Fio(2)) < 80 mm Hg under a Fio(2) of 1.0, a positive end-expiratory pressure of 18 cm H(2)O, and refractory respiratory acidosis (pH < 7.25), despite optimization of conservative therapy.

RESULTS

All patients underwent peripheral cannulation. In 59 cases, vv-ECMO was placed in another facility with ECMO transport by helicopter or ambulance. The mean vv-ECMO support interval was 12 ± 9.0 days (range, 1-67 days). During ECMO, 12 patients (7%) could be extubated and stepwise mobilized. Cannula-related complications during long-term support occurred in 14%, which was mostly minor bleeding. Overall survival was 56%: 58 patients (33%) died during mechanical support, and 20 (11%) died after weaning from the system. The best outcome was noted in trauma patients. Risk factors were mainly advanced age and multiorgan failure.

CONCLUSION

Modern vv-ECMO is an excellent treatment in patients with severe ALF and should be more liberally used.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Schmid C
Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. christof.schmid@klinik.uni-regensburg.de
Philipp A
No affiliation info available
Hilker M
No affiliation info available
Rupprecht L
No affiliation info available
Arlt M
No affiliation info available
Keyser A
No affiliation info available
Lubnow M
No affiliation info available
Müller T
No affiliation info available

MeSH

Acute DiseaseAdolescentAdultAgedCatheterization, PeripheralExtracorporeal Membrane OxygenationFemaleFollow-Up StudiesHumansMaleMiddle AgedRespiratory InsufficiencyRetrospective StudiesTreatment OutcomeVeinsYoung Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21885295

Citation

Schmid, Christof, et al. "Venovenous Extracorporeal Membrane Oxygenation for Acute Lung Failure in Adults." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 31, no. 1, 2012, pp. 9-15.
Schmid C, Philipp A, Hilker M, et al. Venovenous extracorporeal membrane oxygenation for acute lung failure in adults. J Heart Lung Transplant. 2012;31(1):9-15.
Schmid, C., Philipp, A., Hilker, M., Rupprecht, L., Arlt, M., Keyser, A., Lubnow, M., & Müller, T. (2012). Venovenous extracorporeal membrane oxygenation for acute lung failure in adults. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 31(1), 9-15. https://doi.org/10.1016/j.healun.2011.07.013
Schmid C, et al. Venovenous Extracorporeal Membrane Oxygenation for Acute Lung Failure in Adults. J Heart Lung Transplant. 2012;31(1):9-15. PubMed PMID: 21885295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venovenous extracorporeal membrane oxygenation for acute lung failure in adults. AU - Schmid,Christof, AU - Philipp,Alois, AU - Hilker,Michael, AU - Rupprecht,Leopold, AU - Arlt,Matthias, AU - Keyser,Andreas, AU - Lubnow,Matthias, AU - Müller,Thomas, Y1 - 2011/09/01/ PY - 2011/04/11/received PY - 2011/07/20/revised PY - 2011/07/28/accepted PY - 2011/9/3/entrez PY - 2011/9/3/pubmed PY - 2012/5/2/medline SP - 9 EP - 15 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J Heart Lung Transplant VL - 31 IS - 1 N2 - BACKGROUND: Acute lung failure (ALF) is an increasing problem that can be treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). This report summarizes prospectively collected data of an institutional experience with vv-ECMO. METHODS: From January 2007 to December 2010, 176 patients (mean age, 48 ± 16; range, 14-78 years) with ALF refractory to conventional therapy were supported with vv-ECMO. The general indication for vv-ECMO was a partial oxygen pressure/fraction of inspired oxygen (Fio(2)) < 80 mm Hg under a Fio(2) of 1.0, a positive end-expiratory pressure of 18 cm H(2)O, and refractory respiratory acidosis (pH < 7.25), despite optimization of conservative therapy. RESULTS: All patients underwent peripheral cannulation. In 59 cases, vv-ECMO was placed in another facility with ECMO transport by helicopter or ambulance. The mean vv-ECMO support interval was 12 ± 9.0 days (range, 1-67 days). During ECMO, 12 patients (7%) could be extubated and stepwise mobilized. Cannula-related complications during long-term support occurred in 14%, which was mostly minor bleeding. Overall survival was 56%: 58 patients (33%) died during mechanical support, and 20 (11%) died after weaning from the system. The best outcome was noted in trauma patients. Risk factors were mainly advanced age and multiorgan failure. CONCLUSION: Modern vv-ECMO is an excellent treatment in patients with severe ALF and should be more liberally used. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/21885295/Venovenous_extracorporeal_membrane_oxygenation_for_acute_lung_failure_in_adults_ DB - PRIME DP - Unbound Medicine ER -