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What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome?
Curr Opin Crit Care. 2012 Oct; 18(5):527-32.CO

Abstract

PURPOSE OF REVIEW

This article reviews the results of case series and trials which evaluated venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. Potential indications of the technique in this setting are discussed.

RECENT FINDINGS

Major technological improvements in extracorporeal membrane oxygenation (ECMO) machines and the positive results of the conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR) trial have reignited interest in VV-ECMO in patients with severe acute respiratory distress syndrome (ARDS) and persistent hypoxemia or hypercarbia on conventional mechanical ventilation. The technique has also been successfully used as a rescue therapy for the most severe ARDS cases associated with the recent Influenza A(H1N1) pandemic. However, as the CESAR study was criticized for methodological limitations and because results of nonrandomized case-series of ECMO are prone to selection biases, indications for VV-ECMO remain highly controversial.

SUMMARY

Before widespread diffusion of VV-ECMO for severe ARDS, new trials should test the efficacy of early initiation of the technique with tight control of mechanical ventilation in the control group, initiation of ECMO prior to transportation to ECMO centers, and the use of ECMO in every patient randomly assigned to receive it.

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Authors+Show Affiliations

Combes A
Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, Paris, France. alain.combes@psl.aphp.fr
Bréchot N
No affiliation info available
Luyt CE
No affiliation info available
Schmidt M
No affiliation info available

MeSH

Extracorporeal Membrane OxygenationHumansHypoxiaPulmonary Gas ExchangeRespiration, ArtificialRespiratory Distress Syndrome

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22914430

Citation

Combes, Alain, et al. "What Is the Niche for Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome?" Current Opinion in Critical Care, vol. 18, no. 5, 2012, pp. 527-32.
Combes A, Bréchot N, Luyt CE, et al. What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care. 2012;18(5):527-32.
Combes, A., Bréchot, N., Luyt, C. E., & Schmidt, M. (2012). What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Current Opinion in Critical Care, 18(5), 527-32. https://doi.org/10.1097/MCC.0b013e328357f090
Combes A, et al. What Is the Niche for Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome. Curr Opin Crit Care. 2012;18(5):527-32. PubMed PMID: 22914430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? AU - Combes,Alain, AU - Bréchot,Nicolas, AU - Luyt,Charles-Edouard, AU - Schmidt,Matthieu, PY - 2012/8/24/entrez PY - 2012/8/24/pubmed PY - 2013/1/31/medline SP - 527 EP - 32 JF - Current opinion in critical care JO - Curr Opin Crit Care VL - 18 IS - 5 N2 - PURPOSE OF REVIEW: This article reviews the results of case series and trials which evaluated venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. Potential indications of the technique in this setting are discussed. RECENT FINDINGS: Major technological improvements in extracorporeal membrane oxygenation (ECMO) machines and the positive results of the conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR) trial have reignited interest in VV-ECMO in patients with severe acute respiratory distress syndrome (ARDS) and persistent hypoxemia or hypercarbia on conventional mechanical ventilation. The technique has also been successfully used as a rescue therapy for the most severe ARDS cases associated with the recent Influenza A(H1N1) pandemic. However, as the CESAR study was criticized for methodological limitations and because results of nonrandomized case-series of ECMO are prone to selection biases, indications for VV-ECMO remain highly controversial. SUMMARY: Before widespread diffusion of VV-ECMO for severe ARDS, new trials should test the efficacy of early initiation of the technique with tight control of mechanical ventilation in the control group, initiation of ECMO prior to transportation to ECMO centers, and the use of ECMO in every patient randomly assigned to receive it. SN - 1531-7072 UR - https://www.unboundmedicine.com/medline/citation/22914430/What_is_the_niche_for_extracorporeal_membrane_oxygenation_in_severe_acute_respiratory_distress_syndrome L2 - https://doi.org/10.1097/MCC.0b013e328357f090 DB - PRIME DP - Unbound Medicine ER -