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"Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering.
Crit Care. 2016 06 30; 20(1):150.CC

Abstract

Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.

Authors+Show Affiliations

Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. tom.langer@hotmail.it.Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.The Geneva Foundation, Tacoma, WA, USA. Multi Organ Support and Preservation Task Area, U.S. Army Institute of Surgical Research (USAISR), Ft. Sam Houston, Texas, USA.Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

27357690

Citation

Langer, Thomas, et al. ""Awake" Extracorporeal Membrane Oxygenation (ECMO): Pathophysiology, Technical Considerations, and Clinical Pioneering." Critical Care (London, England), vol. 20, no. 1, 2016, p. 150.
Langer T, Santini A, Bottino N, et al. "Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. Crit Care. 2016;20(1):150.
Langer, T., Santini, A., Bottino, N., Crotti, S., Batchinsky, A. I., Pesenti, A., & Gattinoni, L. (2016). "Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. Critical Care (London, England), 20(1), 150. https://doi.org/10.1186/s13054-016-1329-y
Langer T, et al. "Awake" Extracorporeal Membrane Oxygenation (ECMO): Pathophysiology, Technical Considerations, and Clinical Pioneering. Crit Care. 2016 06 30;20(1):150. PubMed PMID: 27357690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. AU - Langer,Thomas, AU - Santini,Alessandro, AU - Bottino,Nicola, AU - Crotti,Stefania, AU - Batchinsky,Andriy I, AU - Pesenti,Antonio, AU - Gattinoni,Luciano, Y1 - 2016/06/30/ PY - 2016/01/19/received PY - 2016/04/27/accepted PY - 2016/7/1/entrez PY - 2016/7/1/pubmed PY - 2017/11/1/medline SP - 150 EP - 150 JF - Critical care (London, England) JO - Crit Care VL - 20 IS - 1 N2 - Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/27357690/"Awake"_extracorporeal_membrane_oxygenation__ECMO_:_pathophysiology_technical_considerations_and_clinical_pioneering_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1329-y DB - PRIME DP - Unbound Medicine ER -