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Alain Combes, Antonio Pesenti, V Marco Ranieri
Mechanical ventilation (MV) remains the cornerstone of acute respiratory distress syndrome (ARDS) management. It guarantees sufficient alveolar ventilation, high FiO2 concentration, and high positive end-expiratory pressure levels. However, experimental and clinical studies have accumulated, demonstrating that MV also contributes to the high mortality observed in patients with ARDS by creating ventilator-induced lung injury. Under these circumstances, extracorporeal lung support (ECLS) may be beneficial in two distinct clinical settings: to rescue patients from the high risk for death associated with severe hypoxemia, hypercapnia, or both not responding to maximized conventional MV, and to replace MV and minimize/abolish the harmful effects of ventilator-induced lung injury...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
T Wollersheim, S Frank, M C Müller, V Skrypnikov, N M Carbon, P A Pickerodt, C Spies, K Mai, J Spranger, S Weber-Carstens
PURPOSE: Indirect calorimetry (IC) is the gold standard for measuring energy expenditure (EE). Due to O2 uptake and CO2 removal by both the extracorporeal lung support (ECLS) membrane and the lungs, a conventional IC is not feasible and no data available. Our MEEP (Measuring Energy Expenditure in ECLS Patients) protocol enables the determination of the REE in patients with ECLS, the comparison to patients without ECLS, and accuracy assessment of estimating equations. METHODS: In the MEEP protocol, a conventional IC is performed and extended by a calculation of the O2 uptake and the CO2 elimination by the ECLS membrane...
February 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
David Zonies
Extracorporeal life support has evolved considerably over the past two decades. Once considered as salvage or experimental therapy in adults, extracorporeal membrane oxygenation (ECMO) is evolving into a mainstream treatment for adult critical care. This is especially true in trauma and high-risk surgical patients, who have traditionally been excluded from consideration. Several technological advances have made this possible. This includes anticoagulant-bonded circuits, device miniaturization, servo-regulated centrifugal systems, and more efficient oxygenators...
May 2017: World Journal of Surgery
Nicolas J Prat, Andrew D Meyer, Thomas Langer, Robbie K Montgomery, Bijaya K Parida, Andriy I Batchinsky, Andrew P Cap
BACKGROUND: Over 32% of burned battlefield causalities develop trauma-induced hypoxic respiratory failure, also known as acute respiratory distress syndrome (ARDS). Recently, 9 out of 10 US combat soldiers' survived life-threatening trauma-induced ARDS supported with extracorporeal membrane oxygenation (ECMO), a portable form of cardiopulmonary bypass. Unfortunately, the size, incidence of coagulation complications, and the need for systematic anticoagulation for traditional ECMO devices have prevented widespread use of this lifesaving technology...
December 2015: Shock
Heidi J Dalton, Duncan J Macrae
OBJECTIVE: Extracorporeal life support has undergone a revolution in the past several years with the advent of new, miniaturized equipment and success in supporting patients with a variety of illnesses. Most experience has come with the use of extracorporeal membrane oxygenation, a modified form of cardiopulmonary bypass that can support the heart, lungs, and circulation for days to months at a time. To describe the recommendations for the use of extracorporeal membrane oxygenation in children with pediatric acute respiratory distress syndrome based on a review of the literature and expert opinion...
June 2015: Pediatric Critical Care Medicine
Ka-Ho Hung, Lung-Huang Lin
Severe adenovirus infection in children can manifest with acute respiratory distress syndrome (ARDS) and respiratory failure, leading to the need for prolonged mechanical support in the form of either mechanical ventilation or extracorporeal life support. Early extracorporeal membrane oxygenation (ECMO) intervention for children with ARDS should be considered if selection criteria fulfill.We report on a 9-month-old boy who had adenovirus pneumonia with rapid progression to ARDS. Real-time polymerase chain reaction tests of sputum and pleural effusion samples confirmed adenovirus serotype 7...
May 2015: Medicine (Baltimore)
Frank Bruenger, Lukasz Kizner, Jan Weile, Michael Morshuis, Jan F Gummert
PURPOSE: A new hemoadsorption device intended as adjunctive treatment for patients with elevated cytokine levels in the setting of SIRS and sepsis has shown promising results. We report on the beneficial application of the device in a patient with cardiogenic septic shock receiving combined extracorporeal life support with rECMO, LVAD, and CVVH despite his highly septic condition. METHODS: A 39-year-old patient presented with fulminant ARDS and cardiogenic septic shock...
February 2015: International Journal of Artificial Organs
Aleksandra Leligdowicz, Eddy Fan
PURPOSE OF REVIEW: To provide a summary of the recent literature on extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome (ARDS), focusing on advances in equipment, current conventional and unconventional indications, complications, and future applications. RECENT FINDINGS: ECMO use has increased during the past 5 years. Advances in cannulation, circuit design, and patient selection have made it a safer therapeutic option in severe ARDS, and its use has become more widespread for nonconventional indications...
February 2015: Current Opinion in Critical Care
V Fanelli, A Costamagna, V Marco Ranieri
Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO(2) removal (ECCO(2)R) techniques have increasingly been applied in patients with severe acute lung injury refractory to conventional mechanical ventilatory support. The objectives of this article are to review current concepts of extracorporeal life support techniques (ECMO and ECCO(2)R systems) and provide the rationale for their application in patients with acute respiratory distress syndrome, chronic obstruction pulmonary disease, and as adjunctive therapy for bridging patients to lung transplantation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Corey E Ventetuolo, Christopher S Muratore
Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome that characterized the 2009 influenza A(H1N1) pandemic have stimulated renewed interest in the use of venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to support the respiratory system. Theoretical advantages of ECLS for respiratory failure include the ability to rest the lungs by avoiding injurious mechanical ventilator settings and the potential to facilitate early mobilization, which may be advantageous for bridging to recovery or to lung transplantation...
September 1, 2014: American Journal of Respiratory and Critical Care Medicine
(no author information available yet)
UNLABELLED: Extracorporeal life support (ECLS) is used in pediatric patients with ARDS in recent 20 years with survival rate from 50 to 67% Venovenous ECLS was used in 1 year 2 months old patient with ARDS and pneumonia developed in postoperative period after gastral esophagoplasty. Purposes of ECLS use were stabilization child's condition and normalization of gas composition of blood with relative lungs repose. Indications for ECLS were increasing respiratory failure, hypoxemia, low respiratory index (PaO2/FiO2 ratio 47...
September 2013: Anesteziologiia i Reanimatologiia
Thilo Fleck, Christoph Benk, Rolf Klemm, Johannes Kroll, Matthias Siepe, Jochen Grohmann, René Höhn, Frank Humburger, Friedhelm Beyersdorf, Brigitte Stiller
OBJECTIVES: Mechanical circulatory support (MCS) is a rescue therapy for infants and children suffering from severe cardiorespiratory failure with specific system-related complications like bleeding, thromboembolism and device failure. Novel circuit components for temporary MCS with improved haemodynamic properties may improve patients' outcome and reduce system-related morbidities. The Deltastream DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a newly designed rotational pump with a diagonally streamed impeller that can be used in children of all ages (priming volume 16 ml, flow 0-8 l/min)...
November 2013: European Journal of Cardio-thoracic Surgery
D W de Lange, M A Sikma, J Meulenbelt
CONTEXT: Although extracorporeal membrane oxygenation (ECMO) was used in many patients following its introduction in 1972, most hospitals had abandoned this experimental treatment for adult patients. Recently, improvements in the ECMO circuitry rendered it more biocompatible. The surprisingly low mortality in patients with severe acute respiratory distress syndrome who were treated with ECMO in the influenza A/H1N1 pandemic of 2009 resurrected interest in ECMO in many intensive care units around the world...
June 2013: Clinical Toxicology
D Roger, J-M Dudouit, D Résière, H Mehdaoui, D Courcier, L Villain, C Léonard, F Roques, G Lebreton
OBJECTIVE: The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean. PATIENTS AND METHODS: All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011...
May 2013: Annales Françaises D'anesthèsie et de Rèanimation
Benjamin S Bryner, Candice Smith, Elaine Cooley, Robert H Bartlett, George B Mychaliska
OBJECTIVE: Adult respiratory distress syndrome (ARDS) secondary to acute pancreatitis is associated with a poor prognosis. We hypothesized that extracorporeal life support (ECLS) may be an effective treatment option for the most severe cases of pancreatitis-induced ARDS. METHODS: We reviewed 8 cases of pancreatitis-induced ARDS that were treated with ECLS at our institution. We collected data on demographics, comorbidities, hemodynamic parameters, and ventilatory support used before ECLS...
December 2012: Annals of Surgery
Ivan Wong, Alain Vuylsteke
A large proportion of critically ill H1N1/2009 patients with respiratory failure subsequently developed ARDS and, to date, about 400 patients receiving extracorporeal life support (ECLS) have been accounted for globally, with a reported survival rate from 63% to 79%. The survival rates of patients with ARDS due to non-H1N1/2009 infections are similar. There is no definite evidence to suggest that patient outcomes are changed by ECLS, but its use is associated with serious short-term complications. ECLS relies on an extracorporeal circuit, with extracorporeal membrane oxygenation (ECMO) and pumpless interventional lung assist (ILA) being the two major types employed in ARDS...
January 2011: Perfusion
Adriano Peris, Giovanni Cianchi, Simona Biondi, Manuela Bonizzoli, Andrea Pasquini, Massimo Bonacchi, Marco Ciapetti, Giovanni Zagli, Simona Bacci, Chiara Lazzeri, Pasquale Bernardo, Erminia Mascitelli, Guido Sani, Gian Franco Gensini
INTRODUCTION: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals. METHODS: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs...
2010: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jennifer Nelson, Bruce Cairns, Anthony Charles
Acute respiratory distress syndrome (ARDS) remains a challenging disease leading to increased mortality in burn patients, and inhalation injury may contribute to the development of severe ARDS. Extracorporeal life support (ECLS) provides a method of gas exchange while allowing time for lung recovery in the setting of early, severe ARDS. Recent study suggests that a selected population of patients with severe ARDS may benefit from ECLS, especially if initiated early. We report a case of a 22-year-old man with Down syndrome who presented with isolated fire-induced smoke inhalation injury...
November 2009: Journal of Burn Care & Research: Official Publication of the American Burn Association
J Kristine Brown, Jonathan W Haft, Robert H Bartlett, Ronald B Hirschl
Acute respiratory distress syndrome (ARDS) has many underlying causes and carries an overall mortality of 40 to 60%. For those patients with severe ARDS who have a predicted mortality of 80 to 100%, extracorporeal life support (ECLS) can provide an extraordinary means of support. We recently demonstrated a survival to hospital discharge of 52% in this subset of patients. ECLS is capable of providing full respiratory and cardiac support, allowing time for the patient to recover from the underlying disease process...
August 2006: Seminars in Respiratory and Critical Care Medicine
Mark R Hemmila, Stephen A Rowe, Tamer N Boules, Judiann Miskulin, John W McGillicuddy, Douglas J Schuerer, Jonathan W Haft, Fresca Swaniker, Saman Arbabi, Ronald B Hirschl, Robert H Bartlett
OBJECTIVE: Severe acute respiratory distress syndrome (ARDS) is associated with a high level of mortality. Extracorporeal life support (ECLS) during severe ARDS maintains oxygen and carbon dioxide gas exchange while providing an optimal environment for recovery of pulmonary function. Since 1989, we have used a protocol-driven algorithm for treatment of severe ARDS, which includes the use of ECLS when standard therapy fails. The objective of this study was to evaluate our experience with ECLS in adult patients with severe ARDS with respect to mortality and morbidity...
October 2004: Annals of Surgery
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