Pumpless arteriovenous extracorporeal lung assist: what is its role?
Extracorporeal lung assist (ECLA) is an established treatment of severe pulmonary failure. Since extracorporeal perfusion is applied in a long-term fashion in this setting, the negative impact on blood compounds is of tremendous importance. Pumpless arteriovenous ECLA (av-ECLA) is an alternatively introduced technique that focuses on reduced blood traumatization. However, due to determining technical and physiological aspects, its clinical application is limited to a highly selected group of patients. Membrane oxygenators with minimal pressure gradients, as well as stable patients' haemodynamics providing a sufficient cardiac output, are the most important prerequisites. With respect to recent reports, characteristic features of av-ECLA, with special emphasis on its physiological background, are reviewed. Accordingly, reasonable indications for its beneficial use are discussed. It is concluded that av-ECLA is a feasible technique when its limitations are accepted. For adequate clinical use, more data concerning indications, as well as time- and technique-related directions are required.
Grubitzsch
H
H
Heart and Diabetes Centre Mecklenburg-Vorpommern, Clinic of Cardiothoracic and Vascular Surgery, Karlsburg, Germany. Grubitzsch@t-online.de
Beholz
S
S
Wollert
H G
HG
Eckel
L
L
D001784:Blood Gas Analysis; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005263:Femoral Artery; D005268:Femoral Vein; D006801:Humans